This is a story about chronic pain. But it’s also a story about stigma: how assumptions about people who use drugs, or previously did, are baked into our health care system—especially when it comes to pain management. Stigma, in this case, replaced compassion, logic and even the most basic standards of care, leaving a man to suffer needlessly for years. It’s a story that needs to be told because Phillip is not alone; his experience echoes countless others.

Phillip Fiuty, who is now my husband, had been in a major car accident in 1982, when he was 18. He seemed to be the least badly hurt person in the car, and helped the other victims at the scene of the crash. It didn’t occur to him until a couple of days later that he had been injured. He declined to go to the hospital at the time of the accident, and his Christian Scientist family discouraged medical care after the fact. 

As a young adult, Phillip used heroin and methamphetamine; each time he tried to quit, he would notice a persistent pain in his neck. In 2007, he quit heroin and meth and decided he needed to face his medical problems head on. He began dealing with his chronic pain within the medical system. 

By early 2017, Phillip’s migraines and neck pain had grown unmanageable. Seeking answers, he visited specialists and was treated for the pain and the migraines. But no one was looking at his spine. Then, that spring, he suddenly lost motor function on his right side. 

Driving to work one morning, he was passing through an intersection when his right hand suddenly fell from the steering wheel into his lap and his foot slipped from the gas pedal. His dominant side had abruptly stopped responding, without warning or sensation. He was able to awkwardly finish the drive using only his left hand and foot, but by the time he arrived, he could barely lift his arm or move his fingers.

He managed to get himself to the ER and an emergency MRI finally revealed the truth: two cervical discs were missing and the nerves in his neck were compressed. It’s likely that he did injure his neck in the 1982 car crash and the discs deteriorated over time. In retrospect, it’s astonishing that this issue went undetected for so long.

A double discectomy and cervical fusion were performed, and for the first time, Phillip began to feel some improvement. He was so grateful to the surgeon. 

One follow-up X-ray was conducted, but that was it. No physical therapy was ordered. These oversights would come back to haunt us.

However, this progress was overshadowed by gaps in follow-up care. He was not directed to limit neck movement during the healing process, nor to use a neck brace. One follow-up X-ray at six weeks was conducted, but that was it. No physical therapy was ordered. These oversights would come back to haunt us.

By 2021, Phillip’s symptoms began to return. Migraines, numbness, swelling, tingling in his hands and sciatica-like pain that radiated up and down his arms. Sometimes his hands would lock up like claws. 

He again sought care and was treated for the migraines and pain with medications like gabapentin, rizatriptan and even the injectable migraine medication Aimovig, but still no one was looking at his cervical spine. 

He also learned that male migraine sufferers often have co-occurring ADHD, and was evaluated for that condition by a psychologist. He received an ADHD diagnosis and began treatment for it. Believing his neck might be the main issue, he wanted to consult with the surgeon who had performed the 2017 surgery. But Phillip’s insurance coverage had changed, and that surgeon was no longer in his network. 

In 2022 Phillip was directed to seek care through Presbyterian Healthcare Services’ Pain and Spine program in New Mexico, where we live. He began the process of care with them. At his first appointment, a urine drug screen came back positive for methamphetamine. The result shocked Phillip, who hadn’t touched meth in 15 years.

Phillip was taking prescribed Adderall for his ADHD at the time. Many providers still don’t understand that this medication, which contains amphetamine salts, can sometimes cause false positives for methamphetamine in drug screens. 

He was told he had been dismissed from care, due to the positive drug screen. “It’s just our policy.” 

Alarmed, Phillip immediately sprang into action. He left voicemails, messaged the pain clinic’s office through its portal, and had a second drug screen conducted through his primary care physician, which came back negative for methamphetamine. 

He received no communication from Presbyterian Pain and Spine in the interim. His follow-up appointment was scheduled three months out, so he waited. Finally, he called the office again prior to his follow-up appointment. 

At that time, he was told he had been dismissed from care, due to the positive drug screen. “It’s just our policy.” 

Phillip was not offered referrals to care for either another spinal surgeon or for treatment for his supposedly current methamphetamine use. 

 “They just dropped me,” he said. He recalled asking the nurse if the positive test result could have been linked to his prescribed medications. Her response? “I don’t know.”

Presbyterian Healthcare Services did not respond to Filter’s request for comment on the substance of this article.

SAMHSA guidelines make clear that clinical decisions should not be made based on a drug test alone. Yet across the United States, patients with a history of substance use are routinely dismissed or undertreated for pain because of stigma, not science.

Fortunately, open enrollment came through my employer, where I had domestic partner benefits. Phillip joined my plan and gained access to other providers. Imaging showed that at least one of the original cervical fusions had failed. Still, this local provider told him he wasn’t “a good surgical candidate” because no one wanted to “redo another surgeon’s work.” He was referred back to pain management instead.

There, he endured multiple failed interventions. One involved a botched attempt to place an IV, despite him explaining, from years of lived experience, that ultrasound guidance would be required. He was poked more than 10 times before the procedure was scrapped. 

I was in the room with him that day, and was in tears myself. I realized I needed to step in, not only as his partner, but as a public health professional.

Phillip found that buprenorphine controlled his pain about 50 percent better than the other medications, with 50 percent less side effects.

Phillip was still in pain every day and was now taking the highest dose of oxycodone available without prior authorization, as well as gabapentin, duloxetine, Adderall and other supportive medications. It was affecting his mood and cognition, and our relationship.

One of my public health roles at that time was educating providers on chronic non-cancer pain management. I gave Phillip a sheet on dosing guidelines and a comparative overview of buprenorphine formulations for pain. He brought it to his provider, who agreed to try it.

The change was immediate.

Phillip found that the buprenorphine controlled his pain about 50 percent better than the other medications, with 50 percent less side effects. He had less sedation, clearer thoughts and better emotional stability. 

Buprenorphine has long been unfairly siloed as a drug “only” for opioid use disorder. But the transdermal patch (Butrans) and buccal film (Belbuca) are FDA-approved for chronic pain. Compared to full-agonist opioids, buprenorphine offers reduced risk of respiratory depression, lower potential for dependence, and unique antidepressant properties due to kappa antagonism and serotonin reuptake inhibition.

It’s not just safer, it’s often better. So why isn’t it offered first?

By 2024, Phillip and I had both reached our limits. I knew our relationship would not survive if he didn’t get the surgery he needed. 

He had a new job, and he was able to select the most comprehensive insurance plan with out-of-network coverage. Every spinal program he contacted wanted to see MRI results from within the last six months, but no doctor locally could seem to get his insurance to authorize and cover an MRI. 

I convinced Phillip to pay out-of-pocket for imaging so that he could be seen. We contacted multiple nationally ranked spine centers. A top-five program on the East Coast agreed to see him. They were mystified that he was a self-referral.

His evaluation with that program, which looked at his whole spine, confirmed that neither cervical fusion from 2017 had ever fused. It also showed major issues in his lumbar spine. 

Phillip underwent two surgeries in 2024: a cervical revision in August, and a lumbar fusion in December. In between those surgeries, both of which lasted more than six hours, we got married.

The difference in care was incredible. The center on the East Coast was much more adept at prior authorizations and getting things approved by insurance. They utilized team care, with the anesthesiologist, the orthopedic surgeon and even a plastic surgeon working in concert. Phillip had a home nurse, physical therapy and post-op imaging to confirm healing. 

Today, he’s still in physical therapy twice a week, tapering his medications, doing more yard work and continuing to heal. 

Stigma almost cost my husband his ability to walk. It nearly cost him his life. And it’s happening to other patients every day.

I think often about how differently this could have turned out. What if he didn’t have a partner with my background? What if we couldn’t afford the better insurance plan, out-of-pocket imaging or cross-country travel? What if he had given up?

And how many other people today are continuing to suffer as he has done—and continuing to face discrimination for past or present drug use—with no end in sight?

I am confident that if Phillip had not gotten the surgeries he needed, he would have eventually returned to using unregulated drugs, or even completed suicide. Stigma almost cost my husband his ability to walk. It nearly cost him his life. And it’s happening to other patients every day.

Pain care in this country is broken. But it’s fixable. It starts by believing patients. By offering buprenorphine early, not as a last resort. By questioning test results and not using drug screens as grounds for exclusion. By rejecting the idea that people with substance use histories are too complicated to help.

Every patient deserves to be heard, treated with dignity and offered real options. Phillip’s story didn’t have to be this hard. No one else’s should be either.

Top photograph of Phillip Fiuty after cervical spinal surgery in August 2024; inset photograph of the author’s wedding day later in 2024. Both photographs courtesy of Athena Huckaby.

The post “They Just Dropped Me”—When Drug-Related Stigma Replaces Pain Care appeared first on Filter.