By Kelly Merrill
When Dr. Merideth Norris was indicted by the DOJ’s New England Prescription Opioid Strike Force in late October of 2022, her pain patients were abandoned to a hostile regulatory and prosecutorial climate. Physicians are fearful about prescribing opioid pain medications and medical professionals are increasingly refusing treatment, rescinding care, and forcing rapid downward tapers that ignore FDA warnings and CDC clarifications that such methods of treatment are dangerous and have serious consequences, including suicide.
Seven months after the Norris indictment, the situation is dire. Pain patients with rare, disabling illnesses and other conditions causing severe, persistent, life-limiting pain, say they cannot find adequate continuing medical care. Further, they have been given no alternative but to drastically reduce or discontinue the use of opioid pain medications that allowed them to function.
The results have been disastrous for those still struggling to find care. I sat down with seventeen legacy pain patients who have been displaced by the DOJ actions. Legacy patients are people who have tried and failed numerous treatments for pain. They have relied on opioid analgesics for many years to manage symptoms.
-Photo by Kelly Merill
Who is Merideth Norris?
Dr. Norris is a Board-Certified Addiction Medicine Specialist. Dr. Norris has been a leading voice in opioid policy and a fierce advocate of treatment options and access for people with substance use disorder. In 2015, Norris was appointed by the then Governor to the Treatment Task Force for the Maine Opiate Collaborative. She was an early-adopter and advocate of harm reduction, offering treatment access to the uninsured.
Norris’s expertise around addiction medicine and the Opioid Epidemic extends to the pain community, as well. She has been an outspoken critic about rigid policy prescribing limits adopted by the state in 2017, which followed soon after the publication of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. She then foretold the unintended consequences for both physicians and patients.
Norris Indictment
Last October, Norris was indicted for illegal distribution of opioids by the DOJ. While people being medically treated for substance use disorder were able to find doctors, disabled pain patients with complex comorbidities could not find care.
The NEPO Strike Force specifically claims to address what they call one of the root causes of the epidemic, “unlawful prescription and diversion of opioids.” They single out doctors and other medical professionals by using the state’s Prescription Monitoring Program. Norris was a top prescriber in private practice; she is the Strike Force’s first target.
As someone who is an expert in the field of opioid policy, who was treating patients with pain-generating illnesses, as well as patients with substance use disorder, it is logical that Norris would be a top prescriber of opioid medications. Further, she was the only doctor who would take on such patients when three doctors from Southern Maine retired during the pandemic, said an anonymous prescriber who contacted me from a restricted number.
If convicted, Norris faces up to twenty years in federal prison.
The Impact of Public Policy
This issue has been ramping up for years. Public outcry over lethal, unintended patient harm, resulting from the 2016 CDC Guidelines, lead to strong actions from agencies tasked with protecting public health. In 2019, the FDA issued a Safety Communication, warning about abruptly discontinuing and rapidly reducing dosages due to precipitated withdrawal, psychological distress, and suicide. And in a rare move, at the end of 2022, CDC finally clarified their stance due to widespread misapplication of the guidelines. But the damage was already done. Six years later, the guidelines, originally intended as recommendations for primary care physicians, were adopted into law. Thirty-eight states have imposed hard prescribing limits.
The CDC’s Guidelines and Maine’s prescribing limits, formed in the early years of the fentanyl crisis, have done nothing to mitigate overdose deaths, which have set records for the past three consecutive years. The restrictions have, however, had a chilling effect on the pain community, resulting in a 40% reduction in opioid prescribing. This seismic shift has left many patients in the state without options.
Devastating Consequences
“Since the limits on prescribing took effect in January of 2017, it has been more difficult for patients with chronic pain to find prescribers willing to use the appropriate and lawful palliative care exemptions in the statute that were designed to assist them,” said Gordon Smith, Director of Opioid Response for the current Governor. Smith was involved in drafting of the 2016 legislation while he served as Executive Vice President for the Maine Medical Association. “The recent enforcement action by the federal government has had an additional chilling effect,” he added.
Physicians are too afraid to go on the record and speak publicly in support of Norris or treat her patients. “They’re hunting us,” said an anonymous prescriber. “They’ve weaponized the Prescription Monitoring Program and there’s always going to be a top prescriber.” When asked about using the palliative care exemption, multiple prescribers have expressed extreme discomfort and an unwillingness to use it because of the current climate.
When Norris was indicted, patients were blindsided. Emergency rooms bridged care by writing prescriptions for five to seven days. Meanwhile, patients scrambled to find practitioners to treat them. Mike Albaum, Chief Medical Officer at Southern Maine Health Care, explained the rocky process of trying to accommodate patients in the aftermath of the Norris indictment. He said he consulted with the Schmidt Institute in Bangor. They set up a plan to reduce and taper patients off their medications or transfer them to another provider for what he calls longitudinal care. He does not plan to use the palliative care exemption that was passed in 2018 because he says they are unclear. That taper clinic is scheduled to close this month.
Pain Patients Speak
The pain patients interviewed had been taking pain medications safely and responsibly for six years to two decades. After the DOJ action, they report dangerous dose reductions that have caused extreme harm and bodily injury, leaving them deeply disabled and unable to function. Of those patients, several who were in recovery from alcohol and drugs for many years have lost their sobriety as they self-medicate. Another is now housebound. Two reported precipitated withdrawals, one experienced multiple seizures, and another’s new medication regimen causes constant vomiting. Several have reported dangerous spikes in blood pressure.
Ms. Snyder
Ms. Snyder, who asked that we not use her first name, is a 48-year-old patient with degenerative disc disease. She said that during her first visit to her new provider, they cut short-term opioid pain relievers by 25%. They continued with an aggressive tapering schedule and eliminated the medication entirely in just three weeks. At the same time, they cut her benzodiazepine Xanax by 25 – 75% per week, eliminating the anxiety medication entirely over just a five-week period. According to revised CDC Guidelines, patients who have been using opioids and benzodiazepines long-term should not have medications reduced by more than 10% per month. Snyder went into precipitated withdrawal, resulting in five bad falls within four weeks. The last one split her forehead open on a windowsill, giving her a bloody nose and two black eyes.
At one point, Snyder reports calling the provider thirteen times, and says they never called back. She then contacted Norris, who prescribed medication for the severe withdrawal she was experiencing.
“Until the DOJ targeted my doctor, I had been on stable doses of opioid analgesics and other medications for twelve years. Now, my eleven-year recovery from alcohol is in jeopardy, my mental health has deteriorated, and I can barely make it to my psychotherapy appointments,” she said. “I am barely hanging on. I can’t move around; I can’t make my bed. These are medications that allowed me to function when nothing else has been effective.”
Elain Pepin
Elaine Pepin, who has been through years of interventional therapies and medication management, is seeking a neurosurgeon who will do her spinal fusion. She detailed over a decade of care that she received from Norris, as well as what she has endured subsequent to Norris’s arrest.
“When I first came to Norris years ago, she helped me reduce my intake of opioid and other medications, and we found a regimen that was still effective,” she said. “In my subsequent visits to the hospital, I’ve been treated like a criminal. I’ve been told, ‘You know, that’s like heroin.’ ‘We don’t do opioids here.’” Pepin wearily explained, “I wouldn’t be taking these medications if I didn’t need them. It’s demeaning, and it’s insulting.”
Pain Advocacy Alliance
Their stories are too numerous to detail. After being turned away from doctor after doctor, some patients fear they won’t survive this and that suicide may be their only answer. Others are actively pursuing legal remedies through litigation against institutions for patient abandonment, refusal to treat, and dangerous, inhumane medical practices.
In the ten weeks following this story, patients’ health continues to deteriorate.
If you or someone you know has been impacted by forced downward tapers or the inability to obtain pain management or you are a prescriber who wants to talk about the current climate, please contact Pain Advocacy Alliance at painalliances@gmail.com.
10 Comments
Angie Taylor Robinson
I have known Dr Norris for many years. She was, at one time, my physician. I have NEVER seen her distribute or divert anything. As for this crock NEPO Strike Force…what a bunch of clowns. How is a government agency going to tell a Dr. how and what to prescribe? What a joke. They were looking for a scapegoat after the “strike force” sat there doing absolutely for years. They had to prove the money they got from the feds was going to use. They should call them NEPO clowns. I know many many people (patients) that were helped by Merideth Norris. I have SENT many people to Dr Norris. This arrest was uncalled for and I will be sitting front row at her trial, waiting to testify, if need be. I can guarantee there will be a lot of people willing to do the same. And we will be picketing the courthouse. The second someone says anything about opioid medications or just about any controlled substance. First you get “the look” of ok they are drug seeking. Then you get “the speech” about how these drugs kill people and addiction isn’t fun…blah blah blah…well, CONSTANT PAIN isn’t fun either and I bet the idiots who give the looks and speeches would have a different opinion if it was them or their loved one. Then comes the speech of how they don’t prescribe “THOSE TYPE” of medications but, we can look for a rehab for you. It’s idiocy at it’s best. It was mostly, those SAME Dr’s who now say no no no that were taking kickbacks from Purdue Pharma for Oxycontin…and were prescribing it like crazy because it was NON addictive…where was NEPO then? Where was Big Brother Government then? No guidelines…no nothing. Miracle drug and WE HAVE ALL SEEN what became of that, haven’t we? This whole arrest, trial, scare tactics is B.S.
Diane Nason
I fully agree!!!! And if I am still alive when this 3 Ring 🎪 Circus, complete with NEPO Clowns, goes to Trial, I too will be there to FULLY SUPPORT Dr. Meredith Norris,DO, in EVERY WAY. Including Testifying in her defense. I fully believe that Dr.Norris will be exonerated. I STAND WITH AND BEHIND DR. MEREDITH NORRIS DO.
Angie Taylor- Robinson
I have known Dr Norris many years, and in that time, have NEVER seen her over prescribe or divert any medications…none! This NEPO Task Force is a damn joke. They are using this Dr as a scapegoat. For a few years after the initiation of this “Task Force” they did NOTHING! Then when questions were asked as to what they were doing with funding all of a sudden, they make an arrest…going after one of the finest nonjudgmental Dr’s the State of Maine has. I know exactly what her patients have gone through, the looks and judgment “New” Dr’s give…and mostly because they do not understand chronic pain. If they did, it would be a whole different story. If no Dr’s want to prescribe these meds…why the hell do they even make them. And Speed tapering does nothing but, HURT THE PATIENT! Since when can a Atty. General or Task Force tell a Dr what she should prescribe to HER patients? These, and other government agencies, are the reason there is a prescription drug problem. Remember OXYCONTIN? And all the BS about it being non addictive? It was a “miracle” drug. And what happened…years later those same government officials stepped in and all of a sudden it was ALL Purdue Pharma’s fault. Yes, most of the blame goes to Purdue but, those govt. agencies should be sharing the blame. This whole arrest, trial, media coverage is just BS. I, personally, will be front and center, ready to testify on Dr. Norris’ behalf and I will be outside that courthouse, with signs, ready to tell EVERYONE exactly who is at fault here.
Kelly
Angie, thank you so much for your comment. Clearly you have first-hand experience and I would very much like to speak with you. I have some things planned to support Norris and pain patients, and I’d love for you to be a part of it. Find me at Pain Advocacy Alliance on FB.
Helen
I don’t know Dr. Norris, but I have dealt with chronic, often severe pain for 40 years. For many years, I had doctors that gave me a limited amount of oxycodone for when all other methods or medicines for pain control did not provide relief from horrible, disabling pain. I was suicidal for many years because of the pain. I did not become addicted. The pain meds were always a last resort. My doctors trusted me and worked with me to try to improve my situation.
About 7 years ago, my primary doctor was brought before the Maine Medical Licensing Board regarding his opioid prescriptions for some of his patients. When asked why he wrote these prescriptions he replied that he was trying to ease suffering.I don’t know anything about his other patients, but he certainly never pushed drugs to me, or acted inappropriately He was a competent, caring doctor who listened well and responded to my many concerns. He referred me to other providers, ordered appropriate testing, we discussed diet and the limited forms of exercise that I was able to tolerate, etc. Eventually, he was fined over a thousand dollars, had to take a medical course on prescribing, and had to work “under supervision” for a couple of years.
Unfortunately, I never knew any of this at the time- the hospital suddenly cancelled my appointments with him, gave no reason, and simply said he was no longer with them. I was in shock. Later, I read comments online from other patients of his who also didn’t know why he was “gone”. Many commented on what a good doctor he was, how he had helped them, and how they wished they knew how to contact him.I never heard or read of any harm he had caused anyone. A good doctor banished because he wanted to ease suffering!
It took me several years before I would venture out to find a new doctor. The one I have now told me at the first appointment that they would NEVER (their emphasis) prescribe opioids for me. I thought that was an incredible thing to say to a patient you just met, not knowing their history or what conditions they live with. And I wasn’t even asking for any at that time, (and haven’t since, obviously.)
Unfortunately, I am continuing to have worsening, unresolved pain in new parts of my body. Several of the conditions I have are poorly understood, if at all.
They treat us like we are crimminals without knowing what it is like to be us.
Please do NOT publish my email.
Kelly Merrill
I was in the same position at one time as a 17-year pain patient and high metabolizer of opioid therapies. I was housebound and bed-bound and in suicidal levels of pain on a regular basis. I’d be happy to talk to you or anyone about what helped me, because perhaps it might help you. I used tools that are within anyone’s reach. I’m sorry for what you have experienced. I feel your story, as it has been mine, and is the story of millions who suffer invisibly. We are losing access so quickly. Five out of the past five pain doctors I had are no longer treating pain patients, whole pharmacy chains are refusing to dispense medications, and the DOJ/DEA keeps cutting quotas and targeting doctors, all under the guise of mitigating the Overdose Epidemic. Their actions are killing people who resort to lethal street drugs and suicide. Three patients known to me died by assisted suicide in the past month (not here). I wish people understood the cost of being so disabled, stigmatized, and marginalized; the cost of not being able to fully participate in your life. We need tools to address this kind of extreme suffering, which is isolating and unnecessarily torturous. There are doctors too afraid to speak out who feel this moral dilemma and are deeply frustrated by the cruelty of policies meant to shield institutions and de-center patient wellness. Life is precious. Every displaced patient I’ve spoken with grieves being able to live it. We’ve got to do better for the most vulnerable.
Darlene Gonzalez
I have been seeing Dr Norris since 2014 and she was the only one who helped me now I’m being forced down to 100 MME and I would rather be a statistic dead than suffering alive
Laurie
Thank you Kelly for speaking up! We need Dr. Norris.
I am absolutely disgusted by the DOJ.
I can’t get out of bed many mornings & my husband has to assist me. I was diagnosed with MLDD. I had the steroid injections. These lasted approximately 2 months than you cannot get additional injections due to possibly causing other complications.
Carpal Tunnel is fun too. Numbness tingling & surprise electric type shocks out of nowhere, let’s add the good times of my torn ligaments/bakers cyst in addition the Anthroscopy that didn’t work!
The incessant negative reports on opiates is sickening! It so happens that this is what works. I went to Nasson after this nightmare occurred to Dr. Norris & was prescribed a nasty medication that doesn’t assist in pain management! I saw variable NP’s every month. They were Not educated in pain management whatsoever! Only 1 nurse would prescribe my ADHD meds. She was heading South. After she left I was left with uneducated NP’s & talked down to as if I were a 5 year old. 1 of the worst places I have gone for help!
Medicine & care comes from Physician’s that are a rare type being Dr. Norris.
This is not an arena for the DOJ!
Diane Nason
Hi… I have been w/ Dr.Norris 11-12 yrs. I have a complicated medical history & was being treated under Palliative Care exemption since 2017. No Dr.s are willing to help me. None. I’m being forced to adhere to Maines ridiculous one size fits all pain med limits, simply because ALL Dr.s are SOOO SCARED of the Feds. For 17 years, I have needed some type of pain meds in order to function at all. That means that now I’m unable to get out of bed unassisted, can’t sleep, eat properly & chronic, severe pain, nerve pain is so relentless and endless, that I am quite literally wasting away. I currently weigh 96 lbs. It’s a very bad situation for me. I too would rather be a statistic dead than suffering alive.
Diane Nason
I fully agree!!!! And if I am still alive when this 3 Ring 🎪 Circus, complete with NEPO Clowns, goes to Trial, I too will be there to FULLY SUPPORT Dr. Meredith Norris,DO, in EVERY WAY. Including Testifying in her defense. I fully believe that Dr.Norris will be exonerated. I STAND WITH AND BEHIND DR. MEREDITH NORRIS DO.