‘Just hell’: Oregon Medical Group patients stranded without pain medications

Pat Montgomery cannot get out of bed without medication.

He has several screws in his back, to help hold his spine together. It took nine surgeries — with another soon to be scheduled — to stabilize his lower spine, where the cushioning cartilage has worn away. Without it, bone rubs against bone.

Most people experience painful degeneration as they age. For Montgomery, a 71-year-old who worked in construction, the condition is extreme.

To walk, to move through his day, to spend time with his wife, Helene, and their grandchildren, Montgomery relies on an assortment of medications. He keeps them locked in a drawer, stored inside a coffee can.

His prescriptions include oxycodone, gabapentin and morphine.

Montgomery manages his 28-day supply carefully. So, last summer, with about a week’s worth of medication left, Montgomery called his clinic, Oregon Medical Group, or OMG, for a routine refill. 

“They would not give him his pain pills,” Helene Montgomery said from their Veneta home. 

“I was freaking out, because I know what happens when I run out of medication,” said Pat Montgomery. “It’s just hell.” 

Desperate, Montgomery called physician assistant Jeff Canter, who wrote his previous prescription. Canter had recently left OMG’s integrative pain management team for another practice. 

Turns out, Montgomery wasn’t the only patient ringing Canter. 

“Some of them were bawling,” Canter said. “It’s heart-wrenching to have somebody call and say, ‘I’ve been without my meds for three weeks now — or even three days — and I’m going into withdrawals, and they won’t even answer my phone calls.’”

Canter estimates that several hundred patients struggled to access both pain medication and supplemental treatments after he left OMG last July. 

He is among a wave of medical professionals who have departed as the clinic grapples with staff turnover and mounting strain on basic patient care — fallout that follows OMG’s 2020 acquisition by Optum, a national health care company and a division of UnitedHealth Group.

OMG is hardly unique, however. Nationwide, the health care system is reckoning with how to treat chronic pain patients, especially for people who were seen for care in a different era of medication management — people like Montgomery, whose problems started 15 years ago. Then, physicians and their assistants were broadly prescribing opioids, guided in part by pharmaceutical claims that downplayed addiction risks.

As the opioid epidemic wore on, the Centers for Disease Control and Prevention modified recommendations, shifting away from medication-centered pain treatment toward interventions such as injections, physical therapy and behavioral approaches. 

At Oregon Medical Group, Canter and patients who spoke with Lookout Eugene-Springfield said, people were being abruptly cut off from medication, rather than guided through gradual tapering, with clear pathways to alternative treatment — a shift they warned could carry dangerous consequences.

‘Just get rid of them’ 

Canter has spent more than 40 years in medicine, moving between military service and civilian care, treating patients while rising through the ranks. But it’s also personal. 

“I always fall back on the fact that I am a chronic pain patient. I empathize,” he said. 

While serving as a Navy hospital corpsman in 1994, he injured his back lifting a patient from a wheelchair to a bed. The injury never fully healed. Over time, it worsened, aggravated by everyday activity, including exercise and the physical demands of his work.

After retiring from the military, Canter was hired by Oregon Medical Group in 2020, in the thick of the COVID-19 pandemic and around the time Optum acquired the clinic. He said he did not notice significant changes at OMG until about two years later.

That was when doctors on the integrative pain team began leaving — some to retire, another over contracting disputes — and Canter found himself absorbing an influx of patients.

Between August 2022 and March 2023, he recalls working nearly every day of the week for almost five months, splitting time between the clinic and his home office, sitting late into the night between two large computer screens to complete patient charts.

“Patients needed care,” Canter said. “These providers left. It’s not their fault.” 

What ultimately led Canter to submit his notice was not the workload, but a shift in approach. 

Oregon Optum’s executive medical director, Dr. Philip Capp, issued new directives to the pain integration team, Canter said. Canter said he was told to: 

• Discharge pain patients who did not have a primary care provider within Oregon Medical Group. The directive came as OMG already discharged thousands of patients in the Eugene area from primary care, leaving many without a regular doctor.
• Discharge pain patients to Oregon Medical Group primary care providers, if they still had one, should their prescriptions exceed certain opioid thresholds. 
• Carry out discharges without individualized review of patient circumstances. 

“I’m a good soldier, I can say, ‘OK, that’s what you want to do, but let’s do it smartly. Let’s wean them down or convert them over to a safer medication. Let’s make sure they have somewhere to go,’” Canter said.

“They said, ‘No, just get rid of them.'” 

Optum denied Lookout Eugene-Springfield’s request to interview Capp and did not respond to specific questions sent by email, despite repeated attempts. A spokesperson, Karrie Spitzer, provided a blanket response:

“Our pain management and prescribing policies for controlled substances are aligned with the Oregon Health Authority and CDC guidelines, including patient compliance with prescription refill criteria. Patient safety is our top priority. Patients are encouraged to contact our pain management team with any questions or concerns.”

Prescription whiplash 

Moxie Loeffler, a doctor who sits on the governor-appointed Oregon Alcohol and Drug Policy Commission, has worked with prescriptions throughout her career and has watched how the management of them has changed over time. 

“A lot of the switches in opioid prescribing have given my patients a lot of whiplash and hurt them a lot over the years,” Loeffler said. 

That whiplash dates back to the 1980s, when health care providers began to recognize that patients’ pain was not being taken seriously. By the early 2000s, pain affected an estimated 76.2 million Americans — more than diabetes, heart disease and cancer combined — according to the National Center for Health Statistics.

So when doctors like Loeffler were in medical training in 2005, pain was taught as the fifth vital sign. Students learned to treat pain as if it could be easily measured, like body temperature or blood pressure.

Pain, however, is not something that can be evaluated objectively with an instrument like an X-ray. For example, a scan can reveal a broken bone, but it cannot show how that injury feels to a patient. Pain scores — such as when a doctor asks a patient to rate their pain on a scale — are subjective when considered on their own.

Still, medical students were taught to take patients at their word, education that persisted for many through 2020. 

Meanwhile, the health care system grew more strained, and clinics were not equipped to offer immediate alternatives such as physical therapy, stress reduction or sleep support for pain. 

“I’ve worked in great clinics,” Loeffler said, but added: “I’ve never seen a clinic that has all these things in one place and available right when the patient comes in complaining of pain. So what we did have is a quick fix.”

The quick fix was opioids.

In that era, corporations such as Purdue Pharma were widely trusted that their products were safe, though later the company admitted it made false claims about the addictive risks of its products like OxyContin.

In response, the CDC issued prescribing guidelines in 2016 and again in 2022. While the CDC meant the guidelines as recommendations, some clinics treated them as a hard rule. 

In a 2024 letter, Oregon Medical Board’s medical director, Dr. David Farris, said the most recent guidelines from 2022 were meant to move doctors away from rigid cutoffs and back toward individual clinical judgment.

Instead, some practitioners grew concerned about the subjectivity of clinical judgment and how those decisions might be scrutinized by the medical board, which oversees medical licenses and regulates clinical practice in the state. 

“The Board is well aware some number of clinicians have shied away from long-term pain management in part or in whole for fear of Board sanctions,” he wrote. “We wish it weren’t so, and the Board is hopeful the realignment in prescribing guidance will provide reassurance to those licensees caring for patients with long-term pain.” 

Lookout Eugene-Springfield asked to talk with the Oregon Medical Board about OMG and issues with patients obtaining prescriptions and treatment. Spokesperson Elizabeth Ross said the board does not grant interviews.

When asked about patient complaints filed with the board in recent months regarding Oregon Medical Group, Ross’ team said the board could not release information, citing confidentiality under Oregon law. 

‘Nobody ends up stranded’

For medical professionals like Loeffler and Canter, how patients are guided through this transition matters.

“They can refill [prescriptions] and keep [patients] stable. They can taper them in these situations, so that nobody ends up stranded,” Loeffler said. “I don’t think that we ought to abandon one whole part of their care and make them vulnerable to using street drugs or overdosing or suddenly having a major pain crisis.”

I don’t think that we ought to abandon one whole part of their care. Moxie Loeffler

Loeffler treats substance use disorder at PeaceHealth, specifically helping patients move to opioid alternatives like buprenorphine, which has a weaker effect than other drugs and helps reduce overdoses. But it’s not a solution that fits everyone, especially for pain. 

In some cases — such as when patients do not respond to buprenorphine or other treatments — people with severe pain may still be prescribed more potent medications like methadone.

Methadone is typically used to help people working through addiction, but its long-acting nature can make it effective for severe, chronic pain.

It is an opioid that was also cut off for some Oregon Medical Group patients, Canter told Lookout Eugene-Springfield. He said those patients were directed to the Lane County methadone clinic. 

That clinic treats people whose primary diagnosis is an opioid use disorder. It does not provide care for patients whose main condition is chronic pain.

But the county’s methadone clinic has seen an increase in people seeking pain management, said Terry Fields, program manager at the Lane County Treatment Center. The increase coincided with a continued decline in the availability of pain treatment across the community, she said. 

More than 1,000 people in Lane County have a methadone prescription for pain, according to data from the Oregon Health Authority, as of 2024, the most recent year with complete data available.

Behind these numbers and policies are families like the Montgomerys. A lack of direction and support during the transition left them destabilized, they said, and in the dark about future care and their ability to function day to day. 

“What OMG did was wrong,” said Pat Montgomery, who eventually received his prescriptions from Fall Creek Pain Management, where Canter now practices.  

For Montgomery, the alternative to medication would be another risky surgery to remove and put new hardware in his back — a procedure a previous doctor at OMG advised him against — and even then, there is no guarantee it would help.

“He can only live on those [medications] to actually move and do something,” said Helene Montgomery. “He would be a vegetable without them and in extreme pain.”