Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Teeth-Gnashing History Repeats Itself

In reading about the AGGA (Anterior Growth Guidance Appliance) dental appliance and the associated problems (“This Dental Device Was Sold to Fix Patients’ Jaws. Lawsuits Claim It Wrecked Their Teeth,” March 1), I noted in your article no reference to a similar problem with the proplast-teflon product to treat TMJ, or temporomandibular joint disorder, from the 1980s and ’90s, which caused equivalent damages. It amazes me that essentially the same story happened again. The proplast-teflon product even resulted in congressional-level investigations. And the product was summarily removed by FDA order throughout the United States.

Thank you for your good investigative work.

— Dr. Abbey Strauss, Boca Raton, Florida

Horrifying story. Dental device sold without undergoing FDA regulation, numerous stories of patients with wrecked jaws and teeth. https://t.co/tCqFk6PFsI via @khnews

— Joseph Ross (@jsross119) March 15, 2023

— Dr. Joseph Ross, New Haven, Connecticut

This problem seems to expand beyond the AGGA device to the Las Vegas Institute’s entire methodology. The same thing was promised/done to me with braces by LVI-trained dental professionals. I was in braces for six years, and my teeth have spaces they cannot fill now — all while I’m still paying off my debt and unable to afford additional work.

— Chrystal Wilson, Roanoke, Virginia

It’s just embarrassing that this happens here.https://t.co/v1kNXof5VQ

— doug hirsch (@dougjoe) February 28, 2023

— Doug Hirsch, CEO of GoodRx, Santa Monica, California

Slipping Through a Billing Loophole

I help support the type of network that this article references (“Bill of the Month: Surprise-Billing Law Loophole: When ‘Out of Network’ Doesn’t Quite Mean Out of Network, Feb. 28). I think it is important for KHN to educate people on narrow-network products, which was the product the Laskey family selected for their medical insurance benefits. These products have lower monthly premium costs for people who select into them, like the Laskeys, but reduce their in-network provider options, hence the term “narrow network.”

These narrow networks may carry out educational webinars, attend open-enrollment fairs, and have a website (in addition to the payer’s website) so that members are educated about the narrow-network offering. With the adoption of more value-based care in the USA, narrow networks are likely to become more prevalent, and more people will need to understand the insurance products, and their networks.

— David Mayo, Denver

#CDC‘s 2016 guidelines that led to crackdown on #opioid prescribing practices now replaced with new guidelines encouraging physicians to focus on needs of individual patients. But the damage is done. https://t.co/J0eNwVkj5b #chronicpain #painmanagement #opioidcrisis #DEA #FDA

— Greg Slabodkin (@Slabodkin) March 15, 2023

— Greg Slabodkin, Niagara Falls, New York

Chronic Pain Patients’ Chronic Rx Hurdles

Saw the article about how the Centers for Disease Control and Prevention guidelines the past few years have scared too many doctors until hardly any prescribe opioids anymore (“New CDC Opioid Guidelines: Too Little, Too Late for Chronic Pain Patients?” March 15).

Just wanted to chime in that I am having the exact same problem. I have chronic pain, arthritis throughout my body, a degenerative disc disorder, and even more documented medical problems. I recently broke my collarbone and was given only a two-day supply of opioid medication for it. And my pain doctor’s office doesn’t even prescribe me opioids.

I’ve also been treated horribly in the past when I was on an opioid. And if it weren’t for my family doctor’s understanding, I would still be living in so much pain that life seemed too hard to live with this much misery. I’m on what they call Tylenol 4, with codeine; it barely holds the pain back, but I still cannot handle cold weather (and I hate the heat) or even doing normal chores around my house without going into such a bad pain state I have to stay in bed. If I were able to get the pain medicine appropriate for my condition, I could actually enjoy things again. But because of the “opioid crisis,” that would make me an addict, by most doctor’s opinions. I know the CDC didn’t mean to make many chronic pain patients live in misery, but in my experience, that’s exactly what has happened. And there’s nothing I can do about it.

So I wanted to thank you for the article because I don’t think society or the medical community truly understands what the guidelines did to people like those in your article, or like me either. Thank you so much for writing that!

— Michelle Shivpuri, Cedar Hill, Texas

Great to see other journalists finally picking this story up https://t.co/b3BN48vE8o but so many are still enthusiastically repeating myths about pain and opioids

— Maia Szalavitz (@maiasz) March 15, 2023

— Maia Szalavitz, New York City

Cost-Cutting Tools You Can Use

I am a 66-year-old female who had a colonoscopy and polyps removed at a hospital. This was my first screening of this kind, and upon completion I was billed $882 out-of-pocket. Luckily I was listening to your “Bill of the Month” coverage on South Carolina public radio. It educated me of my rights to preventive care under Obamacare. I was able to dispute the bill with success. But I must add here that my health insurance company tried to discourage me from challenging this bill. It made me feel that the bill was correct and that I should feel lucky that it was only that much. I was very disappointed, so I persisted to fill out another dispute in which I quoted KHN and threatened further action. Within a few weeks, my insurer rescinded the bill I had to pay $0. Big thanks to KHN-NPR’s “Bill of the Month”!

— Angela Thomas, Myrtle Beach, South Carolina

‘The veterinary tranquilizer xylazine – the choice du jour of local drug dealers to cut fentanyl – can lead to necrotic ulcers and leaves street medics and physicians confused about how best to deal with this wave of the opioid crisis’ https://t.co/pP1AQUHkmn#Xylazine

— Giuseppe Biondi-Zoccai (@gbiondizoccai) February 24, 2023

— Giuseppe Biondi-Zoccai, Rome

Warning: Painting a Graphic Picture of Drug Use

I recently came across your Kensington “tranq dope” article (“Postcard from a Philadelphia neighborhood: As Opioids Mixed With Animal Tranquilizers Arrive in Kensington, So Do Alarming Health Challenges,” Feb. 15). I have been in the health care field for 20-plus years and recently married a recovering addict, so it brought back a bad and vivid memory I’d like to share with the community of Kensington — the users, as well as the first responders, and health care providers, and wound care treatment teams who so graciously step in and up to help individuals suffering from xylazine’s horrific effects.

My husband, Joshua, who became addicted to opioids after being prescribed painkillers for shoulder surgery 20 years ago, was a previous xylazine user only because it was in just about all of the supposed “heroin” bags he bought. One day he said to me, “Why does it feel like something is crawling under my skin?” After looking at his arms, with big nasty-looking sores on them, I replied, “I have no clue.” Thinking he was just “high” and making it up or just hallucinating, I went back to bed. A few hours later, he woke me saying there were worms or maggots coming out of his arms. So, again, I go into the bathroom with him to see what he was talking about, and sure enough it certainly looked exactly like what he had described. Clearly, he needed to be checked out, but being a stubborn, bullheaded man — along with being labeled, judged, and treated poorly previously when seeking medical attention — he did not seek care. A few days later, he was still pulling these things out of his arms and, finally, I persuaded him to be seen by a doctor. The entire doctor’s office couldn’t believe what they were looking at, so after going over everything it could have been, we learned that it was, in fact, a parasite. The doctor’s best explanation was that the drug Josh had injected must have been contaminated with larvae, and it was producing parasites.

Now let’s take a minute and think about this. Hmm. Horse tranquilizer, horseflies, maggots, or worms … whichever you’d like to call them. It makes sense, doesn’t it? So just use caution when treating individuals and please watch for any possible parasites that may not be treated properly. My husband was given antibiotics, a steroid, and a cream to treat the problem and is doing fine now, but the critters have left nasty scars on his arms for him to have a daily reminder of, for sure.

“Tranq dope” is so hard to get off of, and the detox and withdrawal symptoms are extremely hard to handle and overcome, my husband says. Also, there’s not enough information on how to treat or counteract the symptoms. After being clean for just over a year, he relapsed again and went back to the streets of Philly. He is currently incarcerated at a Montgomery County correctional facility, helping his fellow inmates become aware of how serious and dangerous xylazine really is. Our dream is to someday open a fully functional safe house and outreach program within the Philadelphia area to assist as many individuals as possible and show them a better way of life and help them start their new journey.

— Jill Romanishan, Williamsport, Pennsylvania

I don’t know if anyone remembers the drug that Russians were addicted too in the 2000-2010 era. #Krokodil — highly addictive, flesh eating sores which led to amputations, most often: death. Now it’s #tranq https://t.co/jCkPJd6xwg

— RiverRatDoc (@RiverRatDoc) March 13, 2023

—D.B. Pritt, Clayton, New York

Shoring Up Coverage Ahead of the Great Unwinding

Millions of Americans could lose Medicaid coverage soon (“Medicaid Health Plans Try to Protect Members — And Profits — During Unwinding,” March 9). This problem could be solved seamlessly by Congress expanding public option health insurance in all states in 2023. Do petition the White House, the entire U.S. Senate, and the entire House of Representatives to expand it in all 50 states to provide health care to millions of Americans still without health care or who are about to lose state Medicaid coverage soon.

— Piotr Sliwka, Manassas Park, Virginia

Medicaid Health Plans Try to Protect Members — And Profits — During Unwinding https://t.co/fv5GyqWXzu via @khnews // Get help from the health plan during Medicaid unwinding. they don’t want to lose members or continuity of care either.

— Marcella Maguire, Ph.D. (@Cella65) March 9, 2023

— Marcella Maguire, Philadelphia

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Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.