“The number of oxycodone pills is the maximum I will prescribe. Any more than that, you have to consider that the medication just isn’t working.” – Dr. Curole
In one of the final communications I received from Dr. Justin Curole, I was told that because I had reached the maximum number of oxycodone tablets he was willing to prescribe, we had to “consider that the medication just isn’t working.” This wasn’t based on any clinical observation, any data, or any discussion about how I was using the medication. It was simply a policy boundary masquerading as medical reasoning.

At the time, I was already suffering dangerous side effects from buprenorphine products — including near-blackouts and hypotension. Despite that, Dr. Curole continued trying to reintroduce those medications, suggesting I “toggle” back to Belbuca or lower-dose Butrans and put tape over parts of it to lower the dose. There was no safety net. No monitoring. No accountability for the fact that these same drugs had nearly caused serious injury weeks earlier.

Instead of reevaluating the option that had provided real, tolerable pain relief — oxycodone — I was told we should question whether it was “working” simply because a bureaucratic dosage limit had been reached.

This is not pain care. This is policy enforcement under the guise of clinical judgment. And it highlights something that countless pain patients face: being cut off from effective treatment, not because of health concerns, but because their doctors are either unwilling or unable to challenge arbitrary ceilings.

Here’s the message I received from Dr. Curole:

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“Sorry you aren’t feeling well.

I am waiting to see if UCSF pain clinic would contact you. I didn’t get a note from them so I am assuming they are still triaging your referral but will have our team follow up.

In regards to your side effects, I asked Keri to check in but I think she’s out of the office –just in case you get a call in the next days.

You had these side effects previously but were tolerating them as a side effect of getting better pain relief while adjusting your blood pressure medications. Now with less medication and the same side effects it looks like things just aren’t working like they were in the past few months.

The number of oxycodone pills is the maximum I will prescribe any more then that you have to consider that the medication just isn’t working. This is why I keep trying for us to get help of a pain management specialist (outside of Mariya). In the meantime I will check in with Mariya to see if she thinks toggling back to belbuca or trying an even lower dose of butrans would help. I can get back to you with a temporary plan while we coordinate a follow up visit – I am out of office next week.”

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There was no acknowledgement of the harm I experienced on buprenorphine, no reconsideration of a treatment that had worked, and no real alternative offered except referrals and delays.

It’s a pattern we’ve seen throughout this story — medications are removed before alternatives are in place, then reintroduced even after proving unsafe. And if you speak up or ask for what’s worked in the past, you’re treated as suspicious or dismissed.

This message from Dr. Curole will be included in our legal and advocacy exhibits going forward. Because this is not just about me. It’s about every patient being told that their suffering doesn’t fit into someone else’s policy limits.

If you’ve experienced something similar — you’re not alone. And it’s time we start calling this what it is: medical negligence disguised as caution.