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Four out of five older Americans with hearing loss just ignore it, in part because a hearing aid is an unwelcome sign of aging. But what if hearing aids looked like stylish fashion accessories and could be bought at your local pharmacy like reading glasses?

That’s the vision of Kristen “KR” Liu, who’s the director of accessibility and advocacy for Doppler Labs, a company marketing one of these devices. She thinks a hearing aid could be “something that’s hip and cool and people have multiple pairs and it’s fashionable.”

Liu, who has severe hearing loss herself, helped design a device designed to let people with hearing loss blend in. One person may be using the technology to stream music or take a phone call, she says. Another may be wearing it to amplify speech and hear the conversation. “And no one is going to know the difference,” Liu says. “So you’re wearing technology in your ear, proudly.”

The device is a small circular instrument that fits snugly in the ear. It can be adjusted to individual hearing using a smartphone app to control volume, cut out background noise or turn up the sound in a theater. “It’s pretty much a hearing aid,” says Liu, except the company isn’t allowed to call it that.

That’s because the Food and Drug Administration, which regulates medical devices, doesn’t allow hearing aids to be sold over the counter. So devices sold directly to consumers are marketed as “personal sound amplification products,” or PSAPs. They range in price from about $250 to $350 and are considerably cheaper than hearing aids, which can cost up to $6,000 and are typically not covered by Medicare or most private insurance companies. Hearing aids are customized by a hearing specialist such as an audiologist, following a hearing test.

PSAPs can only be marketed as sound amplifiers for people with normal hearing who want to make things louder, like music or the sounds of birds chirping. Hearing loss advocates believe this means people with mild to moderate hearing loss who could benefit from the devices don’t know about them. There are dozens of the devices on the market, but their quality varies wildly, as an analysis of 11 of them last year for hearing care professionals shows. And there’s no easy way for potential purchasers to figure out which work best.

The Hearing Loss Association of America, a consumer group, wants Congress to create a new category of aids for people with mild to moderate hearing loss by passing the Over-the-Counter Hearing Aid Act of2017. (People with severe hearing loss would still need to be seen by a medical professional.) The bill would direct the FDA to come up with safety and effectiveness standards for these new hearing aids.

The FDA is already moving in that direction, and in December said it would no longer require adults to be medically evaluated before buying a hearing aid. Proponents of direct-to-consumer sales hope Congressional action would get the FDA moving faster. A 2016 report from the National Academies of Sciences also endorsed allowing over-the-counter sales.

This could be life changing for people with hearing loss, says Richard Einhorn, a composer of modern classical music who is on the board of the Hearing Loss Association of America.

Early one morning in 2010, he woke up with his ears ringing — a loud, piercing hiss. “I hit the panic button,” Einhorn says. “I jumped out of bed and immediately fell over onto the floor.”

An inner ear infection, likely a virus, had caused him to lose his balance. He went deaf in his right ear. He already had some hearing loss in his left ear. His hearing aids cost $5,000 and were not covered by insurance.

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Composer Richard Einhorn says paying for hearing aids was a struggle on a musician’s income, and supports efforts to gain FDA approval for cheaper devices.

Kevin Rivoli/AP

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Kevin Rivoli/AP

“I’m a composer, for goodness sake,” Einhorn says. “This is not an easy purchase to scrounge up the money for.”

Opening up the hearing aid market would foster competition and drive prices down, says Einhorn.

It would also encourage companies to come up with new and better products, says Liu. She envisions a future that solves one of the biggest problems for many people – hearing in a noisy environment, like a party or a busy restaurant. She wants a hearing aid that would automatically adjust to different sound environments, so she could hear the person talking to her and not the background distraction.

“Nothing like that exists today,” Liu says. “But I very much see something like that down the road.”

Some audio specialists support rolling back regulations, while others are skeptical.

Hearing loss is complex, says Neil DiSarno, chief staff officer for audiology at the American Speech-Language-Hearing Association. This makes it difficult for consumers to “self-evaluate, self-treat and self-monitor,” he says. If people buy their hearing aids directly over the counter, they’ll miss out on all the skills audiologists can teach them, like how to lip read and how to distinguish high frequency sounds, he says.

The market for over-the-counter hearing aids could be huge. More than 35 million Americans have some degree of hearing loss. And for older Americans, not dealing with the problem can have a big impact on age-related cognitive decline, says Dr. Frank Lin, associate professor of otolaryngology at Johns Hopkins University School of Medicine. Lin has done studies looking at the link between hearing loss and cognitive decline.

“The greater the hearing loss, the greater the risk of loss of thinking and memory abilities over time,” he says, which can lead to feelings of insecurity and social isolation – a known risk factor for dementia.

Lin says his findings should serve as a “wake-up call” for policy makers. If people have easier access to more affordable hearing aids, he says, that could lead to benefits that go far beyond hearing.

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Peter Uribe left Chile at 21 with his wife and 2-year-old daughter, landing in Baltimore and finding steady work in construction. His social life revolved around futbol, playing “six or seven nights a week in soccer tournaments,” he says.

A couple of years after his arrival, he broke his foot during a game and afraid of the cost, didn’t seek medical care.

“Some of my family warned me that if I went to the hospital and couldn’t pay the bill, I’d get a bad credit record,” says Uribe, 41, who made about $300 a week and had no health insurance. “I wanted to buy a car or a house someday.” Instead, he hobbled through workdays and stayed off the field for three years; the residual pain is sometimes disabling, even two decades later.

For reasons both economic and cultural, Hispanic men are loath to interact with the health system. Women across all races are more likely to seek care than men. But the gender gap in the Hispanic community is especially troubling to health care providers. Studies show that Latino men are much less likely than Latinas to get treatment.

That is true even though Hispanic men are more likely than non-Hispanic whites to be obese, have diabetes or have high blood pressure. Those who drink tend to do so heavily, contributing to the group’s higher rates of alcoholic cirrhosis and deaths from chronic liver disease. Many take risky jobs such as construction workers and laborers, and are more likely to die from on-the-job injuries than other workers, government data show.

Hispanics’ share of the population is expected to widen from nearly a fifth now to a quarter by 2045. As that number grows, researchers worry that the nation could face costly consequences as long-ignored conditions lead to serious illness and disability.

“It could literally break the health care system,” says José Arévalo, board chairman of Latino Physicians of California, which represents Hispanic doctors and others who treat Latinos.

And now, some medical professionals fear the effects of President Donald Trump’s crackdown on illegal immigrants.

“When the community faces this kind of stress, I worry that people will do unhealthy things, like abuse alcohol, to deal with it,” says Kathleen Page, co-director of Centro SOL, a health center at Johns Hopkins Bayview Medical Center, and founder of the city’s Latino HIV Outreach Program. “That means they may not work as much,” she adds. “They’ll have less money, which means they’re less likely to seek care.”

Welcomed by Baltimore officials, immigrants have driven the city’s Hispanic population, tripling it to 30,000 since 2000.

Here, as elsewhere, evidence suggests that for many Hispanic men, seeking health care is an extraordinary event. Hospital data show they are more likely than Hispanic women, white women and white men to go to the emergency room as their primary source of treatment – a sign that they wait until they’ve no choice but to get help.

Some care providers say medical institutions haven’t done enough to keep Hispanic men healthy, or to persuade them to get regular exams.

“There’s been an ongoing need for institutions to become more culturally attuned and aware of bias,” says Elena Rios, president of the National Hispanic Medical Association, which represents the nation’s 50,000 Latino physicians.

There are some significant differences in health risk and illness rates among Hispanic subgroups – Puerto Ricans are more likely to be smokers, for example. Compared with Hispanics born in the U.S., those born elsewhere have much lower rates of cancer, heart disease and high blood pressure. Overall, Hispanics live longer than whites.

But these advantages may be dissipating as Latinos become Americanized and adopt unhealthy habits such as smoking and diets high in fatty, processed foods.

“I tell people we live longer and suffer,” says Jane Delgado, a clinical psychologist and Cuban-American who serves as president of the National Alliance for Hispanic Health.

Researchers who investigate gaps in cancer testing have found that all ethnic groups and genders have seen a decrease in late-stage colon cancer diagnoses and deaths in recent years — except Hispanic men, who get screened at the lowest rates of any race or ethnic group.

Often, health problems arise after immigrants come up against an insurance barrier. A few years after Jose Cedillo came to Baltimore from Honduras, the 41-year-old cook noticed his legs were often numb or painful. Worried about finances, he eschewed treatment and continued to work, before finally going to a clinic where he was diagnosed with diabetes.

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Jose Cedillo, a 41-year-old former restaurant worker from Honduras, struggles to get health care for his diabetes. He often finds himself without a job and homeless on the streets of Baltimore.

Doug Kapustin/Kaiser Health News

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Doug Kapustin/Kaiser Health News

In the seven years since, his health has so deteriorated he can’t work, is frequently homeless and spends long stints in the hospital. As an immigrant who came to the U.S. illegally, he is not eligible for government-paid insurance or disability payments. And he can’t afford medicine. Instead, he says, “I’ll drink alcohol to numb the pain.”

Part of the problem is that Spanish speakers are underrepresented among medical professionals. After arriving here, Uribe’s family members frequently brought along an English-speaking nephew or niece when they could afford to see doctors. Otherwise, “we’d travel a long ways to find a doctor who spoke Spanish,” he says.

Hospitals frequently lack cultural understanding and bilingual staffing, administrators admit. Though Latinos make up nearly 20 percent of the population, only 5 percent of physicians and 7 percent of registered nurses are Hispanic. That gap has widened as more Hispanics have come to this country during the past three decades, according to a UCLA study released in 2015.

“Too often, people don’t understand what you’re saying, they don’t know what you’re going to charge them, what dietary restrictions you might place upon them,” says James Page, vice president for diversity at Johns Hopkins Medicine. “It creates a trust issue for Hispanics. We’ve got to get better at serving them.”

That is particularly true in mental health. Only 1 percent of psychologists in the U.S. are Hispanic, meaning that Spanish-speaking men who do seek therapy will probably struggle to find it.

In Baltimore, there is only one Spanish-language support group for men who suffer from anxiety and depression, local psychologists and Latino advocates say. The city employs one Spanish-speaking substance abuse counselor. A small handful of bilingual social workers citywide offer reduced-rate counseling sessions, and only three psychiatrists offer therapy sessions conducted in Spanish.

For Peter Uribe, the key to maintaining his family’s health is getting help paying for care. His wife and brother both suffer from epileptic seizures, and his brother’s despondency caused Uribe to become depressed, he says. In 2015, he obtained insurance for his family through a charity program. With the help of now-affordable medicines, his wife’s seizures waned, and he sought help for chronic depression. Since he now speaks English, finding counseling help is easier.

In January, after intervention from a Latino advocacy group, the charity renewed the Uribes’ policy for two years. Peter Uribe calls it a godsend:

“I honestly have no idea what we’d do without it.”

Michael Anft is a Baltimore-based journalist and writer whose work regularly appears in AARP: The Magazine, The Chronicle of Higher Education and other publications.Daniel Trielli, a data journalist at Capital News Service at the Philip Merrill College of Journalism, contributed to this report.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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As House Republicans try to find common cause on a bill to repeal and replace the Affordable Care Act, they may be ready to let states make the ultimate decision about whether to keep a key provision in the federal health law that conservatives believe is raising insurance costs.

Conservatives from the House Freedom Caucus and members of a more moderate group of House Republicans, the Tuesday Group, are working on changes to the GOP health overhaul bill that was pulled unceremoniously by party leaders last month when they couldn’t get enough votes to pass it.

At the heart of those negotiations is the law’s requirement that most insurance plans offer 10 specific categories of “essential health benefits.” They include hospital care, doctor and outpatient visits and prescription drug coverage, along with things like maternity care, mental health and preventive care services.

The Freedom Caucus had been pushing to strip required benefits, arguing that the coverage guarantees were driving up premium prices.

“We ultimately will be judged by only one factor: if insurance premiums come down,” the Freedom Caucus chairman, Rep. Mark Meadows, R-N.C., told The Heritage Foundation’s Daily Signal last month.

But moderates, bolstered by complaints from patient groups and constituents, fought back. And a brief synopsis of a proposal outlined by Rep. Tom MacArthur, R-N.J., suggests that the compromise could be letting states decide whether they want a federal waiver to delete essential health benefits.

“The insurance mandates are a primary driver of [premium] spikes,” Meadows and Sen. Ted Cruz, R-Texas, wrote in March.

But health analysts and economists say that eliminating those benefits probably won’t bring premiums down — at least not in the way conservatives are hoping.

“I don’t know what they’re thinking they’re going to pull out of this pie,” says Rebekah Bayram, a principal consulting actuary at the benefits consulting firm Milliman. She is the lead author of a recent study on the cost of various health benefits.

Opponents of the required benefits point to coverage for maternity care and mental health and substance abuse treatment as things that drive up premiums for people who will never use such services.

But eliminating those benefits wouldn’t have much of an impact, Bayram says. Hospital care, doctor visits and prescription drugs “are the three big ones,” she says. “Unless they were talking about ditching those, the other ones only have a marginal impact.”

John Bertko, an actuary who worked in the Obama administration and served on the board of Massachusetts’ health exchange, agrees: “You would either have very crappy benefits without drugs or physicians or hospitalization, or you would have roughly the same costs.”

Maternity care and mental health and substance abuse, he says, “are probably less than 5 percent” of premium costs.

Of course, requiring specific coverage does push up premiums to some extent. James Bailey, an assistant professor of health economics at Creighton University in Omaha, has studied the issue at the state level. He estimates that the average state health insurance mandate “raises premiums by about one-half of 1 percent.”

Those who want to get rid of the required benefits point to the fact that premiums in the individual market jumped dramatically from 2013 to 2014, the first year the benefits were required.

“The ACA requires more benefits that every consumer is required to purchase regardless of whether they want them, need them or can afford them,” Ohio Insurance Commissioner Mary Taylor said in 2013, when the state’s rates were announced.

But most of that jump was not due to the broader benefits, Bayram says, but to the fact that for the first time sicker patients were allowed to buy coverage.

“The premiums would go down a lot if only very healthy people were covered and people who were higher risk were pulled out of the risk pool,” she says. (Some conservatives want to change that requirement, too, and let insurers charge sick people higher premiums.)

Meanwhile, most of the research that has been done on required benefits has looked at plans offered to workers by their employers, not policies available to individuals who buy their own coverage because they don’t get it through work or the government. That individual market is the focus of the current debate.

Analysts warn that individual-market dynamics differ greatly from those of the employer insurance market.

Bailey says he “saw this debate coming and wanted to write a paper” about the ACA’s essential health benefits. But “I very quickly realized there are all these complicated details that are going to make it very hard to figure out,” he says, particularly the way the required benefits work in tandem with other requirements in the law.

For example, says Bertko, prescription drugs can represent 20 percent of costs in the individual market. That’s far more than in the employer market.

Another big complication is that the required benefits do double duty, Bayram says. They not only ensure that consumers have a comprehensive package of benefits, but enable other parts of the health law to work by ensuring that everyone’s benefits are comparable.

For example, the law adjusts payments to insurers to help compensate plans that enroll sicker-than-average patients. But in order to do that risk adjustment, she says, “all of the plans have to agree on some kind of package. So if you think of essential health benefits as an agreed-upon benchmark, I don’t know how they can get rid of that and still have risk adjustment.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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Pharmaceutical distributors — the middle men in the opioid epidemic — have already been paying out millions to federal and state law enforcement officials for the companies’ role in the crisis. But a new front in the legal battle against opioids has opened. One personal injury lawyer in small-town West Virginia has come up with a creative legal theory to go after these distributors so that small, ravaged communities can collect too.

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House Republicans are mulling over new changes to their health care proposal, hoping to wrangle enough votes to pass a bill that would allow them to keep their campaign pledge to repeal and replace the Affordable Care Act.

The latest proposal allows states to make changes to the ACA’s rules governing health insurance policies and markets, in an effort to allow some states to offer stripped-down policies with lower premiums.

The proposal represents a deal between Rep. Tom MacArthur, R-N.J., who is the head of the moderate Tuesday Group, and Rep. Mark Meadows, R-N.C., who leads the far-right Freedom Caucus. The two groups could not agree on details of an earlier health care plan championed by House Speaker Paul Ryan, known as the American Health Care Act.

The new proposal, which was reported by Politico and The Huffington Post, is an amendment to that bill. It consists of a summary and bullet points rather than legislative language.

Without the full language it’s unclear whether the plan could bring in enough votes to pass, says a senior House Republican aide.

The proposal retains many of the popular consumer protections of the Affordable Care Act, including ensuring that people with pre-existing medical conditions cannot be refused coverage or charged more.

MacArthur, on his Facebook page, said the plan “will make coverage of pre-existing conditions sacrosanct for all Americans.”

But the plan also allows states to waive those protections.

If states requested waivers, people with pre-existing conditions would likely be covered through state-run high-risk pools, which can be expensive for patients and for taxpayers. Many states used high-risk pools before Obamacare with limited success because they weren’t adequately funded, according to a study by the Kaiser Family Foundation.

The plan “would make coverage unaffordable for many older consumers and would segregate high-cost consumers in coverage that would likely be inadequate,” says Timothy Jost, a professor emeritus at Washington and Lee Law School who writes a health policy blog for Health Affairs.

The proposal could also cause premiums to spike for people with medical issues, according to comments posted on Twitter by Topher Spiro, vice president for health policy at the left-leaning Center for American Progress. A person with diabetes could see premiums rise by about $5,600 while someone with metastatic breast cancer could be charged an additional $142,650, he says.

There are some protections against such premium spikes in the proposal, says Rodney Whitlock, vice president of health policy at ML Strategies, who was a Republican Senate staffer when the Affordable Care Act was passed.

He says language that forces states to promise their changes would still protect people with pre-existing conditions, and result in lower premiums, invites people hurt by the changes to sue the state.

The proposal doesn’t mention Medicaid at all, so it may do little to bring in support for the Republican bill. That’s because the American Health Care Act was killed in part because it rolled back Medicaid coverage for millions of low-income people, something moderate Republicans opposed.

“I have a hard time believing that this will be acceptable to moderates in the House, much less the Senate, and will certainly be opposed by all Democrats,” Jost says.

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The United States spends the most on health care per person — $9,237 – according to two new papers published in the journal The Lancet.

Somalia spends the least – just $33 per person.

The data covering 184 countries was collected and analyzed by the Global Burden of Disease Health Financing Collaborator Network, a network of investigators from around the world with expertise in various aspects of health care. In between those two extremes, the spending is quite literally all over the map. And the amount of spending doesn’t necessarily translate into better health care. For more insights, we spoke to Dr. Joseph Dieleman, assistant professor at the Institute for Health Metrics Evaluation at the University of Washington. He authored the two papers, one looking at health financing from 1995 to 2014, and the other estimating future health financing to 2040.

Obviously, wealthy countries spend more on health than do poor countries. Overall, where does the money come from?

There are three different stages as countries develop. Low-income countries spend the least on health, and the sources of that little bit of funding are international donors and people paying out of pocket. In middle-income countries, people still pay out of pocket, but the government has more capacity and is paying for some health care. And in high-income countries, the money comes mostly from government and private insurance.

What’s the impact on health care when people pay out of pocket?

When people are paying out of pocket, the poorest people will forgo treatment — or they’ll have treatment and be thrown into poverty because of medical costs. That’s mostly a problem for poor countries, though the U.S. stands out among high-income countries as having catastrophic medical expenditures that put people into poverty.

Do measures of health, like high life expectancy, improve as medical spending goes up?

Well, yes, but it’s a little hard to prove that higher spending causes better health outcomes. It’s easier to show that higher spending leads to more health services provided and more people covered for health services — and that’s what leads to better health. Generally, as health spending goes up, so do health outcomes. But there are so many outliers.

What outliers?

With development, health outcomes generally improve, but the U.S. is an anomaly. The U.S. and the U.K. are both high-income, highly developed countries. The U.K. spends less per person ($3,749) on health care than the U.S. ($9,237). Despite its high spending, the U.S. does not have the best health outcomes. [Life expectancy, for example, is 79.1 years in the U.S. and 80.9 years in the U.K. And while the U.S. spends more on health care than any country in the world, it ranks 12th in life expectancy among the 12 wealthiest industrialized countries, according to the Kaiser Family Foundation, a non-profit organization focusing on health issues.]

How bad are things in countries that spend very little, $100 a year or less per person, on health care?

Somalia spends the least, only $33 per person per year for health. That’s a really, really small number. And those resources don’t get equitably distributed across the country. If the country averages $33 a year, you know there are many people that get even less, if not zero in health spending. The poorest people won’t get any treatment.

We did our forecast through 2040, and what we find is that for the poorest countries, 2040 won’t likely be that different from today. In 2014, the lowest-income countries spent an average of $120 per person annually; in 2040, it goes up only to $195.

Which low- and middle-income countries are leading the way with innovative trends?

Globally, the movement toward universal health care has been powerful, especially among middle-income countries. You see a wide variety of reforms taking place. Nigeria, for example, is decentralizing the health-care system so spending decisions are made locally based on local needs. Thailand and Mexico stand out in making progress in moving toward universal coverage and insuring that the entire population has access to basic health care. Vietnam is also moving toward universal coverage. They spend only about $400 a person, but they’ve identified a manageable set of essential health care services and work to provide it for the whole population. Somalia and others can look to countries like that as examples for how to do more with less.

Susan Brink is a freelance writer who covers health and medicine. She is the author ofThe Fourth Trimester, and co-author ofA Change of Heart.

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Nearly one and a half million Americans were treated for addiction to prescription opioids or heroin in 2015, according to federal estimates, and when those people get seriously hurt or need surgery, it’s often not clear, even to many doctors, how to safely manage their pain. For some former addicts, what begins as pain relief ends in tragedy.

Max Baker is one such case. He started using prescription pain pills as a teenager in New England, and quickly moved on to heroin. His father, Dr. James Baker, is a physician in the Worcester, Mass., area, and says he saw signs that his son was high on opioids — in Max’s pupils and skin tone. He begged Max to stop.

“He would have slurred speech, and be nodding off at the dinner table, and we’d go to a concert together and he would disappear and come back acting differently,” James Baker says.

It was a long, painful slog, but Max eventually sought help. When he was 22, he was prescribed an opioid called suboxone, a standard relapse prevention drug that helps wean people off opioids. After a year, he’d worked his way off that medication, too.

He earned his high school equivalency degree, and a two-year associate of arts degree. Things were starting to get back on track, his family and friends thought.

“He called me just a few days before Christmas in 2014,” Max’s father remembers. James Baker still has the voicemail message.

“I just wanted to touch base with you,” Max said in the message. “And also I wanted to let you know that I got a job.”

“It didn’t matter to him if he was washing dishes or delivering pizza,” James Baker says. “He was working.”

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Maxwell Baker died on Dec. 28, 2016, at age 23 — one month after a painful car accident and surgery. “He wanted to change the way our society treats addiction,” his family said in his obituary, “because he knew how difficult it was to achieve sobriety and maintain it.”

Courtesy of James Baker

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Courtesy of James Baker

Max signed up at the University of Massachusetts in Lowell to continue his education — he’d decided he wanted to be a doctor, like his father.

By all accounts, the young man’s recovery was a success story. Then, as he drove home from a class one day in late 2016, a single moment derailed everything.

“A young teenage girl didn’t see him and just pulled out in front of him, and they had a major accident,” says James Baker.

Max’s injuries included a broken bone in his hand that required surgery. He told his surgeon — Dr. James Shenko — right away about his addiction, and that he was scared that medication used for anesthesia and pain might cause a relapse.

To minimize that possibility, Shenko turned to the anesthesiologists on the team.

“And it became a big discussion between myself and anesthesia,” Shenko says. “They were uncomfortable treating this patient differently than other patients because they felt that wasn’t fair to the patient.”

There isn’t any definitive guidance for doctors on how to best anesthetize patients like Max during surgery or how to prevent and ease their pain afterward. The anesthesiologists pointed to research showing that opioid-dependent patients who are on relapse prevention drugs (like suboxone) do fine with anesthesia and opioid painkillers afterward. But Max was no longer taking suboxone — he’d been off that medication for a year.

The anesthesiologist wound up using the normal drug cocktail to sedate Max for the surgery — a mix of drugs that included opioids. And the surgery went well.

It was afterward, his father says, when Max was hurting, that the young patient confronted his surgeon and asked for opioids. “I need medicine for this pain,” Max told Shenko. “I need real medicine.”

The surgeon took James Baker aside. “He had mist in his eyes,” Baker remembers. “He put his arm around me, said, ‘I don’t know what to do, Jim.’ “

“It was horrible,” Shenko says. “Because you’re a doctor — you don’t want people to be in pain. But my fear is, ‘this kid is going to go back to — his life is going to be altered because of what we’re doing, in a bad way.’ “

Shenko also feared that if he didn’t give Max the drugs he wanted — if he prescribed a non-opioid and that didn’t work as well — Max would find his own opioid supply.

“I think he would have said, ‘I’m going to take matters into my own hands.’ Absolutely,” Shenko says.

In the end, the surgeon prescribed Max just a small amount of Vicodin — an opioid.

Less than a month later, Max died of a heroin overdose. He was 23 years old.

There’s no way of knowing what triggered the relapse. Had he come off the subxone treatment for his addiction too soon? Did the opioids give him a taste of the drugs he’d previously managed to kick — enough of a taste to relaunch the cravings? Or was he trying to self-medicate — to ease his physical pain from the car accident and surgery — and simply took too much? Dr. Shenko, the hand surgeon, has been asking himself those questions.

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Max at his drum kit. Playing the drums was passion, his family says, as was “creating original music, listening to jazz, rock, and blues, shooting pool, following the Red Sox and Patriots, playing fantasy football with his family, and enjoying card games and chess.”

Courtesy of James Baker

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Courtesy of James Baker

“What could you have done differently, what do you change, how do you do something differently,” Shenko wonders. “How do you treat patients like this?”

He now thinks hospital surgeons and anesthesiologists need to have ready access to addiction specialists, even before the surgery.

“Let’s bring in somebody, a specialist in dependency and addiction into this equation, and let’s manage it through that,” Shenko says.

Dr. Stuart Gitlow, past president of the American Society of Addiction Medicine, agrees. If a surgeon or anesthesiologist were treating a patient with serious diabetes, they’d consult and endocrinologist. Addiction, he says, is no different.

“Whether he gets the opioids or not is less of the question,” Gitlow says. “The biggest question is what do to ensure this patient’s safety going forward during the period for which he’s experiencing pain?”

Gitlow says in Max’s case, it’s not that the addiction treatment didn’t work. It’s that it ended. And an addiction specialist might have made sure the surgery was followed by a stay in a sober living environment, a methadone prescription, or some other kind of treatment.

But there aren’t enough addiction specialists to meet the need. Nearly 2.5 million Americans are said to be addicted to prescription opioids or heroin. And there are only about 5,000 addiction specialists in the country — most of whom aren’t affiliated with hospitals.

It’s a problem that Max’s father now sees all too clearly. He says when Max was in recovery, he’d ask his son what he could do to help him, and Max replied: ” ‘Just be there, Dad. Let me know you’ll always be there.’ “

Now, James Baker says, he wants to be there for others fighting addiction. He’s done what he needs to do to become certified to prescribe suboxone — the same drug that got Max off heroin initially — in the hopes of preventing more tragedies like the one that devastated his family.

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