Because Crohn’s flare-ups by themselves can cause severe pain, Schechtman already had a prescription for oral opioids—but she went to the hospital that day in 2017 because she was so nauseated from the pain that she couldn’t keep them or anything else down. Like Kathryn, she also took benzodiazepines for an anxiety disorder.

That combination—which is both popular with drug users and considered a risk factor for overdose—made the hospitalist in charge of Schechtman’s care suspicious. Without even introducing himself, he demanded to know why she was on the medications. So she explained that she had PTSD, expecting that this disclosure would be sufficient. Nonetheless, he pressed her about the cause of the trauma, so she revealed that she’d been sexually abused as a child.

After that, Schechtman says, the doctor became even more abrupt. “Due to that I cannot give you any type of IV pain medication,” she recalls him saying. When she asked why, she says he claimed that both IV drug use and child sexual abuse change the brain. “‘You’ll thank me someday, because due to what you went through as a child, you have a much higher risk of becoming an addict, and I cannot participate in that,’” she says she was told.

Schechtman says she felt that the doctor was blaming her for being abused. She was also puzzled.

She had been taking opioids on and off for 20-odd years and had never become addicted. Wasn’t that relevant? And how could it be ethical to deny pain relief based on a theoretical risk linked to being abused? She wasn’t asking for drugs to take home; she just wanted to be treated in the hospital, as she had been previously, without issue.

As would later happen for Kathryn, the experience drove Schechtman onto the internet. “I just became obsessed with researching all of it,” Schechtman says. “I was asking people in these online groups, ‘Have any of you been denied opioids due to sexual abuse history?’ And women were coming forward.”

Schechtman eventually joined an advocacy group called the Don’t Punish Pain Rally. Together with other activists in the group, she discovered that the question about sexual abuse history in the ORT unfairly targeted women, but not men. (An updated version of Webster’s tool now excludes the gender difference, but the older one seems to live on in some electronic medical record systems.)

She also found many pain patients who said they had problems with NarxCare. Bizarrely, even people who are receiving the gold standard treatment for addiction can be incorrectly flagged by NarxCare and then denied that very treatment by pharmacists.

Buprenorphine, best known under the brand name Suboxone, is one of just two drugs that are proven to cut the death rate from opioid use disorder by 50 percent or more, mainly by preventing overdose. But because it is an opioid itself, buprenorphine is among the substances that can elevate one’s NarxCare score—though typically it is listed in a separate section of a NarxCare report to indicate that the person is undergoing treatment. That separation, however, doesn’t necessarily prevent a pharmacist from looking at a patient’s high score and refusing to offer them prescriptions.

Ryan Ward, a Florida-based recovery advocate, has taken buprenorphine for nearly a decade. He also has a history of severe back pain and related surgeries. In 2018, when his pharmacy stopped carrying buprenorphine, he tried to fill his prescription at a Walmart and was turned away. Then he visited two CVS’s and three Walgreens, and was similarly stymied.