By Aneri Pattani, KFF Health News

NEW ORLEANS — Elyse Stevens had a reputation for taking on complex medical cases. People who’d been battling addiction for decades. Chronic-pain patients on high doses of opioids. Sex workers and people living on the street.

“Many of my patients are messy, the ones that don’t know if they want to stop using drugs or not,” said Stevens, a primary care and addiction medicine doctor.

While other doctors avoided these patients, Stevens — who was familiar with the city from her time in medical school at Tulane University — sought them out. She regularly attended 6 a.m. breakfasts for homeless people, volunteered at a homeless shelter clinic on Saturdays, and, on Monday evenings, visited an abandoned Family Dollar store where advocates distributed supplies to people who use drugs.

Elyse Stevens, a primary care and addiction medicine doctor, and her husband, Aquil Bey, a paramedic, discuss patient cases at a community breakfast for homeless people in New Orleans. (Aneri Pattani/KFF Health News/KFF Health News/TNS)

One such evening about four years ago, Charmyra Harrell arrived there limping, her right leg swollen and covered in sores. Emergency room doctors had repeatedly dismissed her, so she eased the pain with street drugs, Harrell said.

Stevens cleaned her sores on Mondays for months until finally persuading Harrell to visit the clinic at University Medical Center New Orleans. There, Stevens discovered Harrell had diabetes and cancer.

She agreed to prescribe Harrell pain medication — an option many doctors would automatically dismiss for fear that a patient with a history of addiction would misuse it.

But Stevens was confident Harrell could hold up her end of the deal.

“She told me, ‘You cannot do drugs and do your pain meds,’” Harrell recounted on a Monday evening in October. So, “I’m no longer on cocaine.”

Stevens’ approach to patient care has won her awards and nominations in medicine, community service, and humanism. Instead of seeing patients in binaries — addicted or sober, with a positive or negative drug test — she measures progress on a spectrum. Are they showering daily, cooking with their families, using less fentanyl than the day before?

But not everyone agrees with this flexible approach that prioritizes working with patients on their goals, even if abstinence isn’t one of them. And it came to a head in the summer of 2024.

“The same things I was high-fived for thousands of times — suddenly that was bad,” Stevens said.

Flexible Care or Slippery Slope?

More than 80% of Americans who need substance use treatment don’t receive it, national data shows. Barriers abound: high costs, lack of transportation, clinic hours that are incompatible with jobs, fear of being mistreated.

Some doctors had been trying to ease the process for years. Covid-19 accelerated that trend. Telehealth appointments, fewer urine drug tests, and medication refills that last longer became the norm.

The result?

“Patients did OK and we actually reached more people,” said Brian Hurley, immediate past president of the American Society of Addiction Medicine. The organization supports continuing flexible practices, such as helping patients avoid withdrawal symptoms by prescribing higher-than-traditional doses of addiction medication and focusing on recovery goals other than abstinence.

But some doctors prefer traditional approaches that range from zero tolerance for patients using illegal drugs to setting stiff consequences for those who don’t meet their doctors’ expectations. For example, a patient who tests positive for street drugs while getting outpatient care would be discharged and told to go to residential rehab. Proponents of this method fear loosening restrictions could be a slippery slope that ultimately harms patients. They say continuing to prescribe painkillers, for example, to people using illicit substances long-term could normalize drug use and hamper the goal of getting people off illegal drugs.

Progress should be more than keeping patients in care, said Keith Humphreys, a Stanford psychologist, who has treated and researched addiction for decades and supports involuntary treatment.

“If you give addicted people lots of drugs, they like it, and they may come back,” he said. “But that doesn’t mean that that is promoting their health over time.”

Flexible practices also tend to align with harm reduction, a divisive approach that proponents say keeps people who use drugs safe and that critics — including the Trump administration — say enables illegal drug use.

The debate is not just philosophical. For Stevens and her patients, it came to bear on the streets of New Orleans.

‘Unconventional’ Prescribing

In the summer of 2024, supervisors started questioning Stevens’ approach.

In emails reviewed by KFF Health News, they expressed concerns about her prescribing too many pain pills, a mix of opioids and other controlled substances to the same patients, and high doses of buprenorphine, a medication considered the gold standard to treat opioid addiction.

Supervisors worried Stevens wasn’t doing enough urine drug tests and kept treating patients who used illicit drugs instead of referring them to higher levels of care.

“Her prescribing pattern appears unconventional compared to the local standard of care,” the hospital’s chief medical officer at the time wrote to Stevens’ supervisor, Benjamin Springgate. “Note that this is the only standard of care which would likely be considered should a legal concern arise.”

Springgate forwarded that email to Stevens and encouraged her to refer more patients to methadone clinics, intensive outpatient care, and inpatient rehab.

Stevens understood the general practice but couldn’t reconcile it with the reality her patients faced. How would someone living in a tent, fearful of losing their possessions, trek to a methadone clinic daily?

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Stevens sent her supervisors dozens of research studies and national treatment guidelines backing her flexible approach. She explained that if she stopped prescribing the medications of concern, patients might leave the health system, but they wouldn’t disappear.

“They just wouldn’t be getting care and perhaps they’d be dead,” she said in an interview with KFF Health News.

Both University Medical Center and LSU Health New Orleans, which employs physicians at the hospital, declined repeated requests for interviews. They did not respond to detailed questions about addiction treatment or Stevens’ practices.

Instead, they provided a joint statement from Richard DiCarlo, dean of the LSU Health New Orleans School of Medicine, and Jeffrey Elder, chief medical officer of University Medical Center New Orleans.

“We are not at liberty to comment publicly on internal personnel issues,” they wrote.

“We recognize that addiction is a serious public health problem, and that addiction treatment is a challenge for the healthcare industry,” they said. “We remain dedicated to expanding access to treatment, while upholding the highest standard of care and safety for all patients.”

Not Black-and-White

KFF Health News shared the complaints against Stevens and the responses she’d written for supervisors with two addiction medicine doctors outside of Louisiana, who had no affiliation with Stevens. Both found her practices to be within the bounds of normal addiction care, especially for complex patients.

Stephen Loyd, an addiction medicine doctor and the president of Tennessee’s medical licensing board, said doctors running pill mills typically have sparse patient notes that list a chief complaint of pain. But Stevens’ notes detailed patients’ life circumstances and the intricate decisions she was making with them.

“To me, that’s the big difference,” Loyd said.

Some people think the “only good answer is no opioids,” such as oxycodone or hydrocodone, for any patients, said Cara Poland, an addiction medicine doctor and associate professor at Michigan State University. But patients may need them — sometimes for things like cancer pain — or require months to lower their doses safely, she said. “It’s not as black-and-white as people outside our field want it to be.”

Humphreys, the Stanford psychologist, had a different take. He did not review Stevens’ case but said, as a general practice, there are risks to prescribing painkillers long-term, especially for patients using today’s lethal street drugs too.

Overprescribing fueled the opioid crisis, he said. “It’s not going to go away if we do that again.”

Luka Bair holds a film of buprenorphine, a daily medication considered the gold standard to treat opioid addiction. Bair had been a patient at University Medical Center New Orleans for years, receiving regular prescriptions for buprenorphine. But when Bair’ s doctor was pushed out of the health system, that care was jeopardized. (Aneri Pattani/KFF Health News/KFF Health News/TNS)

‘The Thing That Kills People’

After months of tension, Stevens’ supervisors told her on March 10 to stop coming to work. The hospital was conducting a review of her practices, they said in an email viewed by KFF Health News.

Overnight, hundreds of her patients were moved to other providers.

Luka Bair had been seeing Stevens for three years and was stable on daily buprenorphine.

After Stevens’ departure, Bair was left without medication for three days. The withdrawal symptoms were severe — headache, nausea, muscle cramps.

“I was just in physical hell,” said Bair, who works for the National Harm Reduction Coalition and uses they/them pronouns.

Although Bair eventually got a refill, Springgate, Stevens’ supervisor, didn’t want to continue the regimen long-term. Instead, Springgate referred Bair to more intensive and residential programs, citing Bair’s intermittent use of other drugs, including benzodiazepines and cocaine, as markers of high risk. Bair “requires a higher level of care than our clinic reasonably can offer,” Springgate wrote in patient portal notes reviewed by KFF Health News.

But Bair said daily attendance at those programs was incompatible with their full-time job. They left the clinic, with 30 days to find a new doctor or run out of medication again.

“This is the thing that kills people,” said Bair, who eventually found another doctor willing to prescribe.

Springgate did not respond to repeated calls and emails requesting comment.

University Medical Center and LSU Health New Orleans did not answer questions about discharging Stevens’ patients.

‘Reckless Behavior’

About a month after Stevens was told to stay home, Haley Beavers Khoury, a medical student who worked with her, had collected nearly 100 letters from other students, doctors, patients, and homelessness service providers calling for Stevens’ return.

One student wrote, “Make no mistake — some of her patients will die without her.” A nun from the Daughters of Charity, which ran the hospital’s previous incarnation, called Stevens a “lifeline” for vulnerable patients.

Beavers Khoury said she sent the letters to about 10 people in hospital and medical school leadership. Most did not respond.

In May, the hospital’s review committee determined Stevens’ practices fell “outside of the acceptable community standards” and constituted “reckless behavior,” according to a letter sent to Stevens.

The hospital did not answer KFF Health News’ questions about how it reached this conclusion or if it identified any patient harm.

Meanwhile, Stevens had secured a job at another New Orleans hospital. But because her resignation came amid the ongoing investigation, University Medical Center said it was required to inform the state’s medical licensing board.

The medical board began its own investigation — a development that eventually cost Stevens the other job offer.

In presenting her side to the medical board, Stevens repeated many arguments she’d made before. Yes, she was prescribing powerful medications. No, she wasn’t making clinical decisions based on urine drug tests. But national addiction organizations supported such practices and promoted tailoring care to patients’ circumstances, she said. Her response included a 10-page bibliography with 98 citations.

Liability

The board’s investigation into Stevens is ongoing. Its website shows no action taken against her license as of late December.

The board declined to comment on both Stevens’ case and its definition of appropriate addiction treatment.

In October, Stevens moved to the Virgin Islands to work in internal medicine at a local hospital. She said she’s grateful for the welcoming locals and the financial stability to support herself and her parents.

But it hurts to think of her former patients in New Orleans.

Before leaving, Stevens packed away handwritten letters from several of them — one was 15 pages long, written in alternating green and purple marker — in which they shared childhood traumas and small successes they had while in treatment with her.

Stevens doesn’t know what happened to those patients after she left.

She believes the scrutiny of her practices centers on liability more than patient safety.

But, she said, “liability is in abandoning people too.”

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

By ANDREA RODRÍGUEZ, Associated Press

HAVANA (AP) — Tens of thousands of Cubans demonstrated Friday outside the U.S. Embassy in Havana to decry the killing of 32 Cuban officers in Venezuela and demand that the U.S. government release former Venezuelan President Nicolás Maduro.

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They crowded into the open-air “José Martí Anti-Imperialist” plaza across from the embassy in a rally organized by the Cuban government as tensions between Cuba and the U.S. spike following the U.S. attack Jan. 3 on Venezuela.

The 32 Cuban officers were part of Maduro’s security detail killed during the raid on his residence in Caracas to seize the former leader and bring him to the U.S. to face drug trafficking charges.

“Humanity is experiencing something very complex, and (the US) is governed by a president who considers himself an emperor,” said René González, 64, one of the protesters.

“We must show him that ideas are worth more than weapons,” he said. “This march is a message of our unity. Independence is sacred, and we will defend it tooth and nail if necessary.”

Cuba’s national hymn rang out at Friday’s demonstration as large Cuban flags waved in the chilly wind and big waves broke nearby along Havana’s famed pier. President Miguel Díaz-Canel shook hands with members of the crowd clad in jackets and scarves before speaking to them.

“The current U.S. administration has opened the door to an era of barbarism, plunder and neo-fascism,” he said.

The demonstration was a show of popular strength after U.S. President Donald Trump recently demanded that Cuba make a deal with him before it is “too late.” He did not explain what kind of deal.

Trump also has said that Cuba will no longer live off Venezuela’s oil and money. Experts say the move could have catastrophic consequences since Cuba is already struggling with severe blackouts.

“No one here surrenders,” Díaz-Canel said. “The current emperor of the White House and his infamous secretary of state haven’t stopped threatening me.”

Washington has maintained a policy of sanctions against Cuba since the 1960s to pressure the island’s government to improve its human rights record, end its one-party communist system and allow democracy. The sanctions have been further tightened during Trump’s presidency, suffocating the island’s economy.

“Cuba does not have to make any political concessions, and that will never be on the table for negotiations aimed at reaching an understanding between Cuba and the United States,” Díaz-Canel said. “It is important that they understand this. We will always be open to dialogue and improving relations between our two countries, but only on equal terms and based on mutual respect.”

After the president’s speech, the demonstration transitioned into a parade that Cubans call a “combatant march,” a custom that originated during the time of the late leader Fidel Castro. The crowd was led by a line of people holding pictures of the 32 officers killed.

“Down with imperialism!” the crowd yelled. “Cuba will prevail!”

The demonstration was organized a day after tens of thousands of Cubans gathered at the headquarters of the Ministry of the Armed Forces to pay their respects to the 32 officers slain.

Their remains arrived home on Thursday morning, and they are scheduled to be laid to rest on Friday afternoon in various cemeteries following memorial ceremonies in all of Cuba’s provincial capitals.

Associated Press reporter Dánica Coto in San Juan, Puerto Rico contributed to this report.

By JOSH JACQUOT

In recent years, a shortage of vehicles, rising prices, and high borrowing costs have made it challenging for some people to purchase a new or used vehicle. Thankfully, the automotive market is shifting in ways that could be beneficial if you’re planning to buy a vehicle in the next few months. The auto experts at Edmunds have identified five car shopping trends that you can expect to see in 2026 and have advice on how to take advantage of them to get the best deal.

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More holdout shoppers are returning, boosting used car selection

Many consumers delayed buying a new car over the past several years due to high prices, limited selection and expensive loans. Those deferred purchases resulted in fewer used vehicles being available for sale. But we’re seeing that trend diminish in 2026. More consumers are finally trading in their used vehicles, which is increasing supply and variety in the secondhand market.

That growing inventory can work in your favor. With more used vehicles on the market, pricing pressure shifts back toward dealers, especially on mainstream models. Instead of feeling forced to accept the only car on the lot, you can compare multiple examples of the same model across dealerships and use those price differences as leverage. The more time you spend comparing listings, the easier it becomes to spot an overpriced car and negotiate a good deal.

Trade-in values remain unusually strong

“One bright spot for owners who have held off on a recent purchase will be equity for their trade-in,” says Ivan Drury, director of insights at Edmunds. According to Edmunds transaction data, 7-year-old vehicles that were traded in during 2025 were valued at an average of $14,400. That’s a 72% increase compared to 2019, when 7-year-old vehicles were appraised at just $8,400.

You can use that equity as a negotiating tool. Before visiting a dealership, get multiple trade-in or purchase appraisals from online pricing tools and local dealers. Bringing those numbers with you helps prevent lowball offers and ensures you capture your car’s full value. More money for your old car means you’ll finance less and have lower monthly payments, which is especially important as prices remain elevated.

A surge of off-lease EVs is reshaping the used market

Electric vehicle leasing surged in 2023, and those EVs are now entering the used market as their leases come to an end. The result is a big increase in used EVs for sale in 2026. Many of them will have relatively low miles and significant discounts compared with new EVs.

For shoppers curious about EVs but wary of new-car prices, this is one of the best entry points in years. You can also look for a certified pre-owned EV if you’re concerned about durability. A certified pre-owned vehicle, or CPO, has been thoroughly inspected by the dealership and typically comes with an extended warranty. With more used EVs for sale, pricing is becoming more competitive.

Financing costs are finally easing

High interest rates added thousands of dollars to the cost of buying a car over the last two years. As rates begin to decline and automakers compete for buyers in a softer sales environment, loan offers are improving, and incentive-driven financing is making a comeback. More favorable financing means more of your monthly payment goes to paying for the vehicle instead of interest.

Be sure to compare all available financing options. Getting preapproved by a bank or credit union gives you a baseline, and dealers may be willing to beat it with manufacturer-backed promotions. Even a small interest rate reduction can translate into meaningful savings over the life of a loan, making it one of the most critical areas to shop carefully.

Longer loans and changing vehicle content require extra scrutiny

As prices remain high, more buyers are stretching payments across 72-month or even 84-month loans. While a longer loan lowers the monthly bill, it increases the total amount paid and keeps you upside down longer on a loan, which occurs when you owe more on your loan than the vehicle is actually worth.

To combat the loan-term creep, focus on total cost, not just the monthly payment. A shorter loan may cost more each month but will save money overall. It also helps shorten the time you will be upside down on your loan.

Edmunds says

Together, these trends create a market that rewards savvy shoppers. Rising used-car supply and strong trade-in values can give you more options and enhanced negotiating power. You can use these opportunities to find the right car at the right price in today’s evolving market.

This story was provided to The Associated Press by the automotive website Edmunds. Josh Jacquot is a contributor at Edmunds.

By KEN MORITSUGU and ROB GILLIES, Associated Press

BEIJING (AP) — Breaking with the United States, Canada has agreed to cut its 100% tariff on Chinese electric cars in return for lower tariffs on Canadian farm products, Prime Minister Mark Carney said Friday.

Carney made the announcement after two days of meetings with Chinese leaders. He said there would be an initial annual cap of 49,000 vehicles on Chinese EV exports to Canada, growing to about 70,000 over five years. China will reduce its total tariff on canola seeds, a major Canadian export, from 84% to about 15%, he told reporters.

Canada’s Prime Minister Mark Carney, center, arrives to meet with Chinese President Xi Jinping, at the Great Hall of the People in Beijing, China, Friday, Jan. 16, 2026. (AP Photo/Vincent Thian, Pool)

“Our relationship has progressed in recent months with China. It is more predictable and you see results coming from that,” Carney said.

Carney hasn’t been able to reach a deal with U.S. President Donald Trump to reduce some tariffs that are punishing some key sectors of the Canadian economy and Trump has previously talked about making Canada the 51st state.

Earlier Friday, Carney and Chinese leader Xi Jinping pledged to improve relations between their two nations after years of acrimony.

Xi told Carney in a meeting at the Great Hall of the People that he is willing to continue working to improve ties, noting that talks have been underway on restoring and restarting cooperation since the two held an initial meeting in October on the sidelines of a regional economic conference in South Korea.

Carney looks to improve global governance

Carney, the first Canadian prime minister to visit China in eight years, told Xi that better relations would help improve a global governance system that he described as “under great strain.”

Chinese President Xi Jinping, centre, reacts during a meeting with Canada’s Prime Minister Mark Carney (not in the picture), at the Great Hall of the People in Beijing, China, Friday, Jan. 16, 2026. (AP Photo/Vincent Thian, Pool)

Later, he said at the news conference that the system may give way at least in part to country-to-country or regional agreements rather than the global ones that have underpinned economic growth in the post-World War II era.

“The question is: What gets built in that place? How much of a patchwork is it?” he said.

The new reality reflects in large part the so-called America-first approach of Trump. The tariffs he has imposed have hit both the Canadian and Chinese economies. Carney, who has met with several leading Chinese companies in Beijing, said ahead of his trip that his government is focused on building an economy less reliant on the U.S. at what he called “a time of global trade disruption.”

A Canadian business owner in China called Carney’s visit game-changing, saying it re-establishes dialogue, respect and a framework between the two nations.

“These three things we didn’t have,” said Jacob Cooke, the CEO of WPIC Marketing + Technologies, which helps exporters navigate the Chinese market. “The parties were not talking for years.”

Canada had been aligned with US on tariffs

Canada had followed the U.S. in putting tariffs of 100% on EVs from China and 25% on steel and aluminum under former Prime Minister Justin Trudeau, Carney’s predecessor.

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China responded by imposing duties of 100% on Canadian canola oil and meal and 25% on pork and seafood. It added a 75.8% tariff on canola seeds last August. Collectively, the import taxes effectively closed the Chinese market to Canadian canola, an industry group has said. Overall, China’s imports from Canada fell 10.4% last year to $41.7 billion, according to Chinese trade data.

Carney tried to address the concerns of Canadian automakers and auto workers by saying the initial cap on Chinese EV imports was about 3% of the 1.8 million vehicles sold in Canada annually and that, in exchange, China is expected to begin investing in the Canadian auto industry within three years.

“We’re building (a) new part of our car industry, building cars of the future in partnership, bringing affordable autos for Canadians at a time when affordability is top of mind, and doing it at a scale that allows for a smooth transition in the sector,” he said.

“For the exchange of a small piece of the Canadian market, we have a commitment. We are waiting for an investment commitment in Canada. The real leaders of the new industry. So it’s an agreement that will create the future for our industry.”

But Ontario Premier Doug Ford, the leader of Canada’s most populous province where the country’s auto sector is based, blasted the deal.

“Make no mistake: China now has a foothold in the Canadian market and will use it to their full advantage at the expense of Canadian workers,” Ford posted on social media.

“Worse, by lowering tariffs on Chinese electric vehicles this lopsided deal risks closing the door on Canadian automakers to the American market, our largest export destination.”

China sees an opening under Trump

China is hoping Trump’s pressure tactics on allies such as Canada will drive them to pursue a foreign policy that is less aligned with the United States. The U.S. president has suggested Canada could become America’s 51st state.

Carney, though, noted Canada’s relationship with the U.S. is much more multifaceted, deeper and broader. Canada and China have different systems and disagree on issues such as human rights, he said, limiting the scope of their engagement even as they seek ways to cooperate on areas of common interest.

The Canadian leader leaves China on Saturday and visits Qatar on Sunday before attending the annual gathering of the World Economic Forum in Switzerland next week. He will meet business leaders and investors in Qatar to promote trade and investment, his office said.

Gillies reported from Toronto. Associated Press business writer Chan Ho-him in Hong Kong contributed to this report.