Overview of Addiction Treatment Debate
Dr. Elyse Stevens, a primary care and addiction medicine physician in New Orleans, specialized in treating patients with complex medical histories, including those with long-term addiction. Her patient demographic included individuals with chronic pain, opioid dependence, and those experiencing homelessness. Stevens was known for engaging with patients in various community settings.
Dr. Stevens' Patient Approach
Stevens' methodology involved assessing patient progress across a spectrum of indicators, such as daily hygiene and engagement in family activities, in addition to substance use patterns. This approach emphasized collaboration with patients on their recovery objectives, which did not always prioritize immediate abstinence from all substances. For example, Stevens prescribed pain medication to Charmyra Harrell, a patient with a history of addiction, diabetes, and cancer, after Harrell ceased using street drugs.
This flexible approach has been recognized with awards in medicine and community service.
Differing Treatment Philosophies
National data from the Substance Abuse and Mental Health Services Administration indicates that over 80% of individuals requiring substance use treatment do not receive it due to various barriers. The American Society of Addiction Medicine supports flexible practices, including telehealth, reduced urine drug testing, longer medication refills, and prescribing higher-than-traditional doses of addiction medication. This organization also advocates for recovery goals beyond immediate abstinence.
Conversely, some medical practitioners favor traditional approaches, which may involve zero tolerance for illegal drug use and strict consequences for non-compliance, such as discharging patients who test positive for street drugs to residential rehabilitation. Proponents of traditional methods express concern that flexible approaches could normalize illicit drug use and impede efforts to achieve abstinence. Keith Humphreys, a Stanford psychologist specializing in addiction, suggests that while providing drugs may maintain patient engagement, it may not promote long-term health. Harm reduction, a strategy aligned with flexible practices, is also a subject of ongoing debate, with critics stating it could enable illegal drug use.
Hospital Concerns and Review
In the summer of 2024, Stevens' supervisors at University Medical Center New Orleans began to question her prescribing practices. Concerns included the number of pain pills, the combination of opioids and other controlled substances for the same patients, and high doses of buprenorphine. Supervisors also noted concerns regarding the frequency of urine drug tests and Stevens' continued treatment of patients using illicit drugs rather than referring them to higher levels of care, such as inpatient rehabilitation.
The hospital's chief medical officer stated that Stevens' prescribing pattern appeared "unconventional" compared to local standards, referencing potential legal implications. Stevens provided research studies and national treatment guidelines supporting her methods, arguing that discontinuing prescribed medications could lead patients to exit the healthcare system and potentially experience adverse health outcomes.
University Medical Center and LSU Health New Orleans declined to comment on internal personnel matters but issued a joint statement affirming their dedication to expanding addiction treatment access while maintaining patient care and safety standards.
External Expert Opinions
Two addiction medicine physicians, Dr. Stephen Loyd (Tennessee medical licensing board president) and Dr. Cara Poland (Michigan State University), reviewed the complaints against Stevens and her responses. Both concluded that her practices were within acceptable bounds for addiction care, particularly for complex patient populations. Dr. Loyd noted the detailed nature of Stevens' patient notes, distinguishing them from patterns associated with inappropriate prescribing. Dr. Poland highlighted that denying all opioids to patients, even those with addiction histories, may not always be clinically appropriate, especially for conditions like cancer pain, and that dose reduction can require extended periods. Dr. Humphreys, without reviewing Stevens' specific case, cautioned against long-term prescribing of painkillers, citing their role in the opioid crisis.
Employment Termination and Investigation
On March 10, Stevens was instructed by her supervisors to cease work due to an ongoing review of her practices, resulting in the transfer of hundreds of her patients to other providers. One patient, Luka Bair, reported experiencing severe withdrawal symptoms due to a three-day lapse in buprenorphine medication access following Stevens' departure. Bair's subsequent referral to more intensive programs was deemed incompatible with their full-time employment, leading Bair to seek care from a different physician.
In May, the hospital's review committee concluded that Stevens' practices were "outside of the acceptable community standards" and constituted "reckless behavior." The hospital reported her resignation during the investigation to the state's medical licensing board, which initiated its own inquiry. This development led to Stevens losing a subsequent job offer. As of late December, the Louisiana state board's investigation into Stevens' license was ongoing, with no public action reported.
In October, Stevens relocated to the Virgin Islands to work in internal medicine. She indicated that her departure was motivated by concerns over institutional liability rather than direct patient safety. Stevens expressed concern for the welfare of her former patients in New Orleans.