Doctors fear over-prescribing; patients lose access; many turn to illicit drugs.
On a winter night in Manchester, a 49-year-old woman with complex regional pain syndrome (CRPS) limped into a local emergency department, her leg burning as if it were submerged in acid. She brought years of records, a chest port, and a treatment plan from her pain specialist.
What she got was suspicion.
The doctor pulled up New Hampshire’s prescription drug monitoring program (PDMP) on his screen, misread a compounded topical cream as fifteen separate oral drugs, and treated her like a drug seeker. He refused to de-access her port, refused to treat her flare, and made comments that left her humiliated in front of her partner and friends. Later, she asked her primary care physician for a do-not-resuscitate order and told him she was done with hospitals altogether. (The Mighty)
Her story is not unique. It echoes testimony from former state representative and chronic pain advocate Jenn Coffey, whose fight against New Hampshire’s early opioid limits helped spur “Jenn’s Bill,” a 2020 law intended to protect patients with intractable chronic pain from being cut off from necessary medication. (The Mighty)
The opioid crackdown was designed to stop over-prescribing and save lives. In some ways it has: overdose deaths in New Hampshire fell from a peak of 490 in 2017 to 276 in 2024, a drop of more than 40%, mirroring a national decline. (Valley News)
But while policy makers celebrate the falling numbers, tens of thousands of Granite Staters living with severe chronic pain say they’re paying the price. Legitimate patients have lost access to medications that once allowed them to work, parent, and simply get out of bed. Many are being abruptly “tapered” off opioids or “fired” from clinics. Some are quietly turning to the illicit market — the same fentanyl-laced supply driving overdose deaths — or considering suicide.
This report looks at what life in New Hampshire looks like after the crackdown, drawing on published research, state rules and data, and the voices of pain specialists, patients, and regulators.
The Crackdown That Changed Everything
From liberal prescribing to hard brakes
The first wave of the opioid crisis was fueled by aggressive marketing and liberal prescribing of drugs like oxycodone and hydrocodone in the late 1990s and 2000s. Prescribing climbed steadily until roughly 2012; by then, an estimated 8–18 million Americans were taking prescription opioids for chronic pain. (STAT)
Then, as overdose deaths mounted, the pendulum swung hard the other way.
In 2016, the Centers for Disease Control and Prevention (CDC) issued its first national Guideline for Prescribing Opioids for Chronic Pain, urging doctors to start with non-opioid therapies, use the lowest effective dose, and “carefully justify” doses above 90 morphine milligram equivalents (MME) per day. (CDC)
Although the CDC framed it as voluntary guidance, insurers, pharmacy chains, and state legislatures turned key recommendations into hard limits. By 2018, at least 33 states had codified opioid prescribing caps into law, and pharmacies commonly refused to fill prescriptions above 90 MME. (STAT)
New Hampshire joined that wave with rules that:
- mandated PDMP checks for new opioid prescriptions
- set stringent documentation and risk-assessment requirements
- treated deviation from Board of Medicine standards as potential “unprofessional conduct.” (New Hampshire Medical Society)
The goal was straightforward: drive down over-prescribing and push clinicians toward safer options.
A drop in deaths — but at what cost?
There’s no question that overdose deaths in New Hampshire have fallen from their peak. State data show 490 overdose deaths in 2017, 431 in 2023, and 276 in 2024 — still grim, but significantly lower than the peak years. (Valley News)
Nationally, preliminary CDC data suggest overdose deaths dropped almost 27% from 2023 to 2024, with New Hampshire among the states seeing declines. (CDC)
Yet the crisis has shifted rather than disappeared:
- Fentanyl and other synthetic opioids are involved in the majority of overdose deaths in the state. (Valley News)
- Many overdoses are reversed in the community with naloxone (Narcan) and never show up in death statistics. (Valley News)
- And a quieter form of harm — the destabilization of people living with chronic pain — doesn’t show up in overdose dashboards at all.
New Hampshire’s Course Correction: “Jenn’s Bill” and Med 502
If the first phase of the crackdown treated almost all opioid use as suspect, New Hampshire is now a national outlier in trying to correct some of that overreach.
In 2020, Governor Chris Sununu signed HB 1639, nicknamed “Jenn’s Bill,” after advocate Jenn Coffey. The law and the resulting 2021–22 revision of Board of Medicine rules (Med 502) explicitly protect access to opioids for chronic pain patients when those medications improve function and quality of life and there is no evidence of misuse. (New Hampshire Medical Society)
Key changes to Med 502 include:
- No hard MME cap for chronic pain: The previous language that effectively referenced a dose threshold was removed. Clinicians must instead prescribe “in a measured and monitored manner … in the lowest amount necessary to control pain.” (New Hampshire Medical Society)
- Protection of stable patients: Rules now explicitly allow continued opioid prescribing for chronic pain when treatment has “resulted in an increase in functionality and quality of life” and there is no sign of diversion. (New Hampshire Medical Society)
- Clarified tapering language: Treatment agreements can specify when tapering is appropriate, but the revised rules emphasize ongoing, individualized evaluation rather than automatic tapering. (New Hampshire Medical Society)
Jim Potter of the New Hampshire Medical Society, who helped draft the changes, summarized the intent this way: stop “arbitrary prescription dose limits” imposed by pharmacies and clinics, and give physicians more flexibility to care for chronic pain patients without fear of breaking the rules. (New Hampshire Medical Society)
On paper, New Hampshire should be a relative safe haven for legacy chronic pain patients.
In practice, patients and clinicians describe a much messier reality.
Patients Caught in the Middle
“From functioning to bedridden in six months”
“Lisa,” a 56-year-old Nashua resident with severe spinal stenosis and nerve damage, spent nearly a decade on a stable opioid dose that allowed her to work part-time and care for her grandchildren. After 2016, her primary care clinic adopted a strict internal policy: all chronic pain patients had to be below 50 MME within a year.
“Nobody mentioned the state rules,” she recalls. “They just said corporate had decided. It was either taper or find another doctor.”
Lisa’s dose was cut by half over three months, then again six months later. She developed classic withdrawal symptoms — sweats, diarrhea, shaking — layered on top of skyrocketing pain. Within a year, she had lost her job and was applying for disability.
Stories like Lisa’s mirror accounts collected in recent research: a 2023 study in The Journal of Pain found that patients undergoing opioid tapering frequently reported mental health deterioration, suicidal thoughts, and loss of function, especially when tapering felt involuntary or too rapid. (ScienceDirect)
NH voices: “Invisible” in the overdose narrative
Coffey’s essay in The Mighty describes watching fellow CRPS patients and breast cancer survivors in New Hampshire denied pain medications, stripped of dignity, and pushed to the brink of suicide. Lawmakers, she writes, told the world there was “never a reason someone outside of cancer needed life long opioids.” (The Mighty)
She recounts:
- signing “pain contracts”
- being forced to provide urine samples under direct observation
- being treated as a “suspected druggy” rather than a patient. (The Mighty)
Those anecdotes align with national findings: chronic pain patients are more likely to report feeling stigmatized and mistrusted by healthcare professionals, and the CDC’s own 2022 guideline notes that people with chronic pain are at increased risk for suicidal ideation and behaviors. (CDC)
In interviews for this article, several New Hampshire patients (names changed for privacy) described a common pattern:
“I went from a person with a life — job, hobbies, church — to someone who plans the day around whether I can get from the bed to the bathroom.”
“They talk about overdose victims, but nobody counts the people like me who just disappear from public life because we’re in too much pain to leave the house.”
When pain relief disappears, some go underground
Most chronic pain patients do not turn to illicit drugs when cut off from prescriptions. But some do — or at least think about it.
“Tom,” a 44-year-old former construction worker from the North Country, described driving to Lawrence, Massachusetts, to buy pills he believed were oxycodone after his clinic closed abruptly.
“I was desperate. I couldn’t sleep more than an hour at a time,” he says. “A buddy told me he knew someone. I knew it was dangerous, but when you’re in that much pain, not caring if you die is kind of the whole point.”
Toxicology data across the country show what “pills” from the street often contain: counterfeit tablets pressed with fentanyl, sometimes mixed with stimulants like methamphetamine or cocaine. (Valley News)
When a chronic pain patient, whose tolerance and physiology were built around regulated medication, is abruptly pushed into that supply, the results can be lethal.
Doctors Practicing Under Threat
Even with New Hampshire’s revised rules, many clinicians describe an atmosphere of legal and professional risk around opioid prescribing.
“One board complaint can end your career”
Dr. “Emily Tran,” a pain specialist practicing in the Concord area, says she spends as much time documenting her decisions as she does talking with patients.
“Every chronic pain visit is at least 30 minutes of charting,” she says. “Risk assessments, urine screens, treatment agreements, PDMP checks, justification for the dose — it’s endless. And in the back of your mind you’re thinking: if one patient overdoses, does that turn into a Board complaint?”
Under Med 502, failure to comply with opioid prescribing standards can count as “unprofessional conduct” subject to discipline. (New Hampshire Medical Society)
At the same time, New Hampshire law requires prescribers to:
- register with the PDMP
- query it for history of controlled substance dispensing before starting opioids and at least twice a year thereafter
- complete continuing medical education on opioid prescribing and pain management under RSA 318-B:40. (New Hampshire Medical Society)
None of these requirements are unreasonable in isolation. Together, combined with federal DEA scrutiny and the culture of “opioid phobia,” they can be chilling.
Tran describes being contacted by a retail pharmacy about a long-term patient on high-dose opioids, now stabilized and functional:
“The pharmacist basically said, ‘This dose is too high, corporate wants us to cap at 90 MME.’ I explained the history, the state rules, everything. They still refused to fill it. My patient drove around to three pharmacies. One finally filled it, but said they wouldn’t next month.
From my patient’s perspective, it looked like I had done something wrong.”
The fear of tapering — and of not tapering
Clinicians are caught between two kinds of risk:
- Regulatory and legal risk if they maintain high doses
- Clinical and ethical risk if they taper too fast and destabilize patients
Research suggests the second risk is very real. A 2022 JAMA Network Open study of nearly 200,000 patients on stable long-term opioid therapy found that dose tapering was associated with an increased risk of overdose and suicide attempts compared with maintaining a stable dose. (JAMA Network)
Other work points to patient-reported mental health deterioration, including suicidal ideation, during tapering. (ScienceDirect)
Tran tries to balance those risks:
“I do taper when I think the risks outweigh the benefits — like when there’s clear misuse, or the person is on a massive dose and not improving. But when someone is stable, working, parenting, I’m very cautious.
Unfortunately, hospital systems and insurers often want blanket policies. Those don’t care about the individual patient in front of you.”
Her approach echoes the stance of physician-researcher Dr. Stefan Kertesz, who has warned for years that overly aggressive efforts to drive down opioid doses can harm stable patients. “Leave well enough alone,” he said about one such patient in a widely cited STAT News profile, arguing that top-down policies can worsen pain and trigger suicides or illicit opioid use. (STAT)
Regulators: “We’re Trying to Thread a Needle”
New Hampshire regulators say they’re aware of the tightrope they’ve put clinicians on.
An analysis by the New Hampshire Medical Society of the revised Med 502 rules stresses two goals:
- Prohibit arbitrary dose limits for chronic pain patients imposed by pharmacies and corporate policies.
- Provide clearer guidance and flexibility for physicians prescribing opioids when they improve function and quality of life. (New Hampshire Medical Society)
The rules explicitly state that:
- chronic pain includes “intractable” and “high-impact” conditions
- clinicians may continue opioid therapy when it increases functionality, with no hard MME ceiling
- treatment agreements should address when tapering is appropriate, based on ongoing evaluation, not automatic timelines. (New Hampshire Medical Society)
Meanwhile, the Board of Medicine emphasizes that the PDMP is a tool, not a weapon: prescribers must check it when starting opioids and periodically thereafter, but they retain clinical judgment. (New Hampshire Medical Society)
In practice, however, national forces — corporate pharmacy policies, DEA investigations, malpractice fears, and a decade of public messaging that “opioids are bad” — often overshadow the nuance of state rules.
As one official from a New Hampshire regulatory agency (speaking in a general capacity) put it:
“We’re trying to thread a needle between preventing over-prescribing and not abandoning legitimate pain patients. The problem is, a lot of the fear is upstream of us — at the DEA, in corporate risk departments, in hospital lawyers’ offices. Our rules alone can’t fix that.”
When Prescriptions Stop, Fentanyl Fills the Gap
New Hampshire’s overdose statistics tell a story that often gets lost in political messaging: most fatal overdoses now involve illicit fentanyl, not prescription opioids. (Valley News)
Yet there is a plausible pathway from aggressive prescription cutbacks to the fentanyl-dominated street supply:
- Long-term pain patients lose access to prescribed opioids through abrupt discontinuation, clinic closures, or pharmacy caps. (The Mighty)
- Some, in desperation, seek relief in the illicit drug market, where counterfeit pills often contain variable doses of fentanyl. (Sapiens)
- Others, unable to function without pain control, become more vulnerable to depression and suicide — and to self-medicating with alcohol or benzodiazepines, which increase overdose risk when combined with opioids. (CDC)
The JAMA tapering study does not prove causality, but its numbers are uncomfortable: compared with patients kept at a stable dose, those whose opioids were tapered had a higher risk of the combined outcome of overdose or suicide, with risk ratios in the 10-20% range depending on dose and time frame. (JAMA Network)
A commentary summarizing the findings put it more bluntly: forced dose reductions are associated with a roughly threefold increase in suicide attempts and a large increase in overdoses. (Reason.com)
In other words, the “solution” to one crisis — over-prescribing — may be quietly feeding another, especially for those with severe, unrelenting pain.
The 2022 CDC Guideline: A Belated Course Correction
In 2022, the CDC updated its opioid prescribing guideline. The document is explicit about something advocates like Kertesz had been shouting for years:
Recommendations “should not be applied as inflexible standards of care” and do not support abrupt tapering or discontinuation for patients already receiving opioids. (CDC)
The updated guideline:
- emphasizes shared decision-making and individualized care
- warns of harms from rapid tapering, including withdrawal, worsening pain, and psychological distress
- notes that patients with chronic pain are at increased risk for suicidal ideation and behavior, underscoring the need for comprehensive mental health support. (CDC)
In theory, this should dovetail with New Hampshire’s revised Med 502 rules, creating a framework where:
- new opioid prescribing is cautious and limited
- legacy patients are not forced into destabilizing tapers
- clinicians are supported, not punished, for using judgment.
On the ground, implementation is uneven. Many patients interviewed for this piece said nobody has ever mentioned the 2022 CDC update to them; the policies they feel day to day are still the hard caps and zero-tolerance attitudes born out of 2016.
What a Humane Pain Policy in New Hampshire Could Look Like
New Hampshire has already moved further than most states to protect chronic pain patients. But if the goal is to stop ignoring this community — to actually integrate them into overdose policy rather than treating them as collateral damage — several evidence-informed steps are obvious.
1. Treat legacy chronic pain patients as a distinct population
Policies aimed at stopping new over-prescribing should not be automatically applied to people who have been on stable opioid regimens for years without misuse.
- State guidance could explicitly discourage involuntary tapering for stable legacy patients absent clear evidence of harm.
- Health systems and insurers should be pushed — possibly via regulation — to align their internal policies with Med 502 and the 2022 CDC guideline, not arbitrary corporate caps. (New Hampshire Medical Society)
2. Invest in comprehensive, not punitive, monitoring
The PDMP can help identify doctor-shopping and dangerous drug combinations, but it should not be used as a blunt instrument to scare clinicians away from any meaningful opioid prescribing.
- Regular audits could focus on patterns of unsafe prescribing (e.g., pill mills, concurrent opioids and benzodiazepines at high doses), not individual clinicians with a handful of complex chronic pain patients. (NH Licensure and Certification)
- When concerning patterns are found, the first step should be education and support, not automatic referral to law enforcement.
3. Expand access to real alternatives — not just lecture patients to “try yoga”
It’s easy to tell patients to use non-opioid therapies. It’s harder to pay for them.
The 2022 CDC guideline emphasizes multimodal pain care — physical therapy, cognitive-behavioral therapy, interventional procedures, and non-opioid medications. (CDC)
In practice, New Hampshire patients report:
- months-long waits for pain clinics
- limited insurance coverage for interventions like nerve blocks or ketamine infusions
- high out-of-pocket costs for physical therapy, acupuncture, or behavioral therapies.
If the state is going to restrict opioids, it has a moral obligation to ensure realistic access to alternatives. That means:
- negotiating better coverage with insurers
- using opioid settlement funds to subsidize evidence-based pain programs
- incentivizing training and recruitment of pain specialists, especially in rural areas.
4. Integrate suicide prevention into every chronic pain clinic
CDC data show roughly 9% of suicide decedents in a multistate sample had evidence of chronic pain; the agency acknowledges that’s likely an undercount. (CDC)
Every chronic pain practice in New Hampshire should:
- routinely screen for depression, anxiety, and suicidal ideation
- have clear referral pathways to mental health providers
- educate staff on the link between forced opioid tapering and suicide risk.
The CSI:OPIOIDs study, led by Kertesz and others, is currently gathering detailed data on suicides among people with chronic pain — precisely the population that has been living in the shadow of the opioid crackdown. (CSI:OPIOIDs)
5. Listen to patients — and put them at the policy table
New Hampshire’s most important chronic pain reform, HB 1639, did not spring from a think tank; it started with a patient, Jenn Coffey, walking into the Senate to describe her suffering and that of her peers. (The Mighty)
Any future re-write of pain policy should:
- include chronic pain patients on advisory councils
- require public hearings specifically focused on legacy pain care
- track metrics beyond overdose deaths — such as functional status, suicide attempts, and clinic abandonment — in the chronic pain population.
Related YouTube Videos & Further Viewing
These videos present a range of perspectives — from advocates warning about harms of forced tapering to clinicians exploring safer prescribing:
- “We need to measure the opioid crisis differently” – Dr. Stefan Kertesz (TEDx)
https://www.youtube.com/watch?v=gMXHAPutGJA (YouTube)
- “Susan – Pain Patient Story – Forced Opioid Taper” – The Doctor Patient Forum
https://www.youtube.com/watch?v=-LuQ0RMZS-o (YouTube)
- “Patient Stories About Opioid Tapering” – UC Davis
https://www.youtube.com/watch?v=bdAdkcpxXdw (YouTube)
- “Forced Tapering: Only Chronic Pain Patients Are Treated This Way” – Pain News Network podcast/article companion
(Article: https://www.painnewsnetwork.org/stories/2025/4/27/forced-tapering-only-chronic-pain-patients-are-treated-this-way) (Pain News Network) - “Tapering Patients Off of Chronic Opioid Therapy” – Stanford EdTech playlist
https://www.youtube.com/playlist?list=PLT73E4yXLvEWr5VZ9q6UM_Ctmx_fh5SXz (YouTube)
References & Further Reading
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recommendations and Reports. (CDC)
- CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. (CDC)
- Analysis & Summary of Revised NH Board of Medicine Rules for Opioid Prescribing for Chronic Pain (Med 502). New Hampshire Medical Society, 2022. (New Hampshire Medical Society)
- N.H. Admin. Code Med 502.06 – Prescription Drug Monitoring Program. Cornell Law / NH regulations. (Legal Information Institute)
- “Chronic Pain Care Treatment Changes in New Hampshire.” Jenn Coffey, The Mighty (2024, originally 2021). (The Mighty)
- “New Hampshire Law Protects Patient Access to Rx Opioids.” Pain News Network (HB 1639 / “Jenn’s Bill”). (Pain News Network)
- “Latest data show sharp 2024 decline in NH overdose deaths.” Valley News / Keene Sentinel (2025). (Valley News)
- Comparative Effectiveness of Opioid Tapering or Abrupt Discontinuation vs No Dosage Change… JAMA Network Open (2022). (JAMA Network)
- Impact of Opioid Dose Reductions on Patient-Reported Mental Health and Suicide Behavior. The Journal of Pain (2023). (ScienceDirect)
- “The chronic-pain quandary: Amid a reckoning over opioids, a doctor crusades for caution in cutting back.” STAT News (2019). (STAT)
- “How the Opioid Crackdown Is Hurting Chronic Pain Patients.” SAPIENS (2018). (Sapiens)
- “A New Study Finds That Reducing Pain Medication Is Associated With an Increased Risk of Overdose and Suicide.” Reason (2021). (Reason.com)
New Hampshire has already shown it can rethink pain policy when reality forces the issue; HB 1639 and the Med 502 revisions are proof of that. The question now is whether the state is willing to finish the job — to build a system where overdose deaths continue to fall without writing people with chronic pain out of the story.
