Balancing Chronic Pain and Addiction Treatment in Kansas

You do not need another lecture about the opioid crisis. You are living inside it. But there is one Kansas-specific piece of context worth knowing, because it explains why your prescriber has been acting differently lately, and why the treatment world you are about to step into is more careful than it used to be.

Between 2020 and 2023, at least 63% of overdose deaths in Kansas involved an opioid — and among those opioid-involved deaths, at least 80% involved fentanyl ³. That second number is the one that changed everything. Fentanyl showing up in the illicit supply is the reason a missed dose, a borrowed pill, or a switch to something bought outside a pharmacy carries risk it did not carry a decade ago. It is also part of why prescribers are more cautious about renewals, dose increases, and long-term therapy — even for people like you, whose pain is real and whose original prescription was legitimate.

This is not framed here to scare you or shame you. It is framed to explain the room you are walking into. Kansas clinicians know the fentanyl reality. That is exactly why a treatment program that takes your pain seriously — and does not just tell you to tough it out — matters more now than it would have five years ago.

Here is something that might reframe the last few appointments you have had.

When your doctor asked you to try physical therapy first, or wanted a urine drug screen, or said they needed prior authorization to keep you on a higher dose past 90 days — that was not personal. It was Kansas policy doing what Kansas policy does. Kansas Medicaid requires prior authorization to exceed a 90-day supply of opioid claims for chronic pain, and the documentation asks about prior taper attempts, PDMP review, and coordination with a single prescriber ⁴. A draft update from KDHE in April 2025 goes further and expects at least two nonopioid ancillary treatments to have been tried, unless something makes them medically inappropriate ⁵.

KDHE’s provider education materials also spell out what Kansas expects from prescribers day to day: honest assessment, a written treatment plan, informed consent, patient agreements, periodic reviews, and consultation when a case is complicated ⁶. None of that is designed to punish you. It is designed to make sure someone is watching the whole picture — pain, function, risk — instead of just refilling a bottle.

Read it another way: the state already assumes that people with chronic pain deserve a coordinated plan. You asking for the same thing during addiction treatment is not a strange request. It is the standard of care Kansas has been building toward for years. You are asking your treatment team to do exactly what your prescriber is already being asked to do.

For a long time, the story in your head might have been: the CDC came down hard on opioids, prescribers panicked, and people like you got left holding the bag. There is truth in that. But the 2022 update rewrote a lot of that story, and almost nobody told the patients.

The 2022 CDC Clinical Practice Guideline lays out 12 recommendations for clinicians caring for adults with acute, subacute, and chronic pain ⁷. The tone underneath those recommendations matters as much as the numbers. The full guideline says plainly that it is meant to support person-centered decisions about pain care — not to hand prescribers a rigid ceiling and walk away ⁸.

Read that again. Person-centered. That includes you.

What this means in a real exam room is that your clinician is expected to weigh your function, your history, your pain, and your risk together, and to make a call with you rather than at you. It also means that if a treatment team ever tells you your pain is not their problem because you have a substance use issue, they are out of step with the guideline the rest of the country is trying to follow.

You may have spent years quietly deciding what you are. Weak. Broken. An addict. A person who should have known better.

None of those labels are clinically useful, and most of them are not true.

NIDA states it directly: some chronic pain patients become dependent on opioids and need medical support to stop ¹³. That is not a footnote. That is the fact sheet. Your body adapted to a medication you were prescribed for a real reason, and now stopping that medication takes help. That is biology doing what biology does.

The peer-reviewed literature on people who live with both chronic pain and opioid use disorder points in the same direction. A collaborative approach that treats substance use and pain together is the recommended path — not a choice between them ⁹.

What you are carrying is a clinical situation with a clinical answer. It is heavy. It is also treatable. And the fact that you are still reading, still weighing whether to reach out, means the part of you that wants a different next year is louder than the shame. Trust that part.

When people picture addiction treatment, they picture the removal of a substance. That is one piece. It is not the whole picture, and for you, it cannot be the whole picture. If a program only subtracts, and never adds anything back for your pain, you are going to leave — or worse, relapse — and everyone involved will call it a failure of willpower. It is not. It is a failure of design.

Integrated care is a different design. It rests on four pillars that lean on each other.

1. The first is a real medical evaluation. Not a checkbox intake. A clinician who sits with your pain history, your imaging, your surgeries, your prescribing timeline, and your current dose, and treats all of it as information — not evidence against you.
2. The second is nonopioid therapies used seriously, not as filler. Physical therapy, targeted procedures, non-opioid medications, sleep repair, and behavioral pain skills all belong here.
3. The third is medication options for opioid use disorder when they fit, including buprenorphine in cases where a single medication may help both pain and dependence.
4. The fourth is behavioral care — therapy for the pain, the trauma, and the anxiety that often live in the same body.

A 2023 systematic review of collaborative-care models found that several trials improved pain-related outcomes, some reduced opioid prescription doses, and some improved buprenorphine treatment outcomes ¹⁰. Translation: when a team coordinates these pillars, people hurt less and use less. Both.

You may have heard about buprenorphine as a medication for opioid use disorder. What you may not have heard is that it is also studied as a pain medication, and that is the piece that changes the conversation for someone in your situation.

The clinical argument is straightforward. Buprenorphine behaves differently from traditional Schedule II opioids and is described in the literature as a safer alternative for patients who need an opioid to manage chronic pain, largely because it carries less abuse potential ¹¹. For some people, one carefully managed medication can address dependence and pain at the same time, instead of stacking two separate prescriptions with competing risks.

Now the honest part.

A systematic review and meta-analysis of buprenorphine for chronic pain found a beneficial effect on pain intensity overall, but only a small effect in patients with comorbid chronic pain and opioid use disorder ¹². Small does not mean nothing. It also does not mean guaranteed relief. The authors caution that the data are limited and study designs vary.

What that means for you: buprenorphine is a reasonable option to ask about, especially if you are on long-term opioid therapy for pain and also worried about dependence. It is not a magic bridge. Whether it fits depends on your pain type, your history, and a clinician who takes both halves of the picture seriously.

If a program hands you a yoga mat and calls it a pain plan, walk out. If a program pretends nonopioid care is soft, walk out of that one too. The truth sits between those poles.

The peer-reviewed review of chronic pain and opioid use disorder points toward a collaborative approach that pairs substance-use treatment with active pain management, including nonopioid options used with intent ⁹. That means specific, measurable tools with real evidence behind them:

• Physical therapy tailored to your injury or condition
• Non-opioid medications like certain antidepressants and anticonvulsants for nerve pain
• Targeted injections or procedures where appropriate
• Cognitive behavioral therapy for chronic pain
• Sleep treatment
• Graded movement

Kansas policy already assumes these tools belong in the plan. The April 2025 draft prior-authorization criteria from KDHE expects at least two nonopioid ancillary treatments to have been attempted for chronic pain, unless something makes them medically inappropriate ⁵.

Read that as validation, not another hoop. The state is saying, in writing, that your care should include more than a bottle. A program that treats nonopioid care as central — not decorative — is a program built around the same idea. That is the room you want to be in.

Detox is the part you have probably rehearsed in your head the most. The shaking. The nausea. The bone-deep restlessness that shows up right about the time your pain flare does. If you have been on opioids for a real medical reason, that overlap is not in your head — it is your nervous system doing two hard things at once.

Holland Pathways runs medically monitored detox on its Wichita campus, with physician oversight through the withdrawal window. That matters here because the person managing your comfort is a clinician who can look at your pain history alongside your withdrawal symptoms and treat both, instead of treating one and dismissing the other. NIDA is direct about this: chronic pain patients who have become dependent on opioids need medical support to stop ¹³. Not willpower. Support.

What that looks like in practice is a plan that separates withdrawal symptoms from your underlying pain, uses nonopioid comfort measures where they help, and does not pretend day three is going to feel like day one. You will not be handed a clipboard and told your pain is somebody else’s department.

One of the quiet cruelties of chronic pain is that nobody can see it. You have probably had a doctor glance at you, decide you look fine, and adjust your care based on that glance. If that has ever happened to you, the fear of it happening again is part of what has kept you from asking for help.

Holland Pathways builds its clinical team around Masters-level clinicians who work with you directly on the therapy side — pain, trauma, anxiety, sleep, the whole tangle. Alongside that, the campus integrates wearable biotech from Huml Health that tracks real-time signals like sleep quality, stress, and heart rate. That data does not replace what you tell your team. It backs you up.

When your sleep collapses on a Tuesday night, your clinician sees it Wednesday morning. When your stress spikes during a certain therapy topic, that shows up too. This is the kind of coordinated visibility the collaborative-care literature points to when it describes trials that improved pain outcomes and reduced opioid doses ¹⁰. Your pain becomes a pattern on a screen, not a claim you have to defend.

Two weeks is not enough time to rebuild a life that pain and dependence have been reshaping for years. You already know that. So does the clinical evidence.

Holland Pathways offers 60-day residential treatment on its 64-bed Wichita campus, with a full continuum that steps down through partial hospitalization, intensive outpatient, outpatient, and aftercare. Roughly 15% of the people served come in with dual diagnosis needs — addiction plus a co-occurring condition like PTSD, depression, anxiety, or bipolar disorder — and the program is trauma-informed by design.

Sixty days gives your team the runway to try nonopioid pain tools seriously, adjust medications, and see whether an option like buprenorphine fits your situation, which the literature supports as a reasonable path for some patients managing pain and dependence together ¹¹. It also gives you time. Time to sleep. Time to move. Time to be a person your pain is not the loudest thing about.