Lynn R. Webster, M.D.

This article, in a slightly edited form, first appeared on Pain News Network on September 1, 2025.

Awake, Not Woke: How Politics in Medicine Harms Patients

By Lynn R Webster M.D.

Somewhere between facts and social media, “woke”—a perfectly good word for being awake to reality—got transmogrified into a slur. If that alchemy puzzles you, too, consider this brief field manual for the Anti-Alarm-Clock Caucus: a how-to on mistaking earplugs for policy and empathy for extremism.

Culture-war rhetoric chills evidence-based care and worsens outcomes. Let me explain what we should do instead.

If you’ve ever sat with someone who was in real pain, you know how brittle the “anti-woke” script sounds in exam rooms. Patient-centered conversation becomes suspect; motivational interviewing gets mocked as coddling; and a clinician trying to tailor a taper to a patient’s specific needs is accused of ideology. The risk isn’t a bruised ego—it’s disengagement. People clamp down, underreport use, skip follow-ups, and show up again only when they’re much sicker. The irony is stark; even critics who rail at “woke medicine” still rely on the public-health infrastructure they deride when it’s time to manage the fallout.

Here’s the magic trick that members of a political group perform. They rebrand attentiveness as excess and turn “be aware of harm” into “behold the woke mind virus.” Once they frame awareness as contagion, politicians can sell indignation like energy drinks, and any practice that looks like noticing the individuality of a patient—bias training, person-first language, or trauma-informed care—can be dismissed as ideology rather than craft. Because they like to think of themselves as honorable, they follow a set of prescribed rules including:

Rule one: relabel compassion as “coercion.” When a clinic swaps “addict” for “person with a substance use disorder” because it reduces stigma and improves engagement, they accuse the “word police” of forcing the change in nomenclature. Opposing any sign of empathy requires less energy than reading the literature and seems far more satisfying than measuring outcomes. The National Institute on Drug Abuse (NIDA) advises using person‑first, non‑stigmatizing language—e.g., “person with a substance use disorder” rather than “addict”—to reduce bias in clinical care.  In fact, in the International Journal of Drug Policy, John Kelly and Cassandra Westerhoff reported that the term “substance abuser” prompts more punitive judgments against the patient even when trained mental health professionals are involved.

Rule two: recode lifesaving tools as culture war. Naloxone, syringe services^, and overdose-prevention centers are tedious in one way. They work. So, label them “woke enabling,” then starve them. It saves leaders from saying the quiet part—“I oppose what works”—out loud while ensuring the body count stays offstage. The CDC reports Syringe Services Programs (SSPs) are “safe, effective, and cost-saving” and “do not increase illegal drug use or crime.” It concludes that syringe services programs are associated with ~50% lower HIV/HCV incidence, and reductions exceed two‑thirds when combined with medications for OUD. HHS adds that harm reduction is “critical to keeping people who use drugs alive.”

In Massachusetts, communities implementing overdose education and nasal naloxone distribution (OEND) saw 27% lower opioid overdose death rates at modest program scale and 46% lower at higher scale versus communities without OEND.

Rule three: flatten complexity into blame. Fentanyl potency, housing collapse, and workforce shortages are complex, unglamorous problems. “Woke drug policy failed” fits on a bumper sticker. When Oregon struggled amid a fentanyl wave, the vibe merchants—outrage marketers who sell mood over evidence—declared decriminalization to be the villain; nuance (and timelines) seldom survive a press conference. The best evidence to date is that Oregon’s Measure 110’s decriminalization was not associated with an increase in fatal overdoses after accounting for fentanyl’s spread; the state later re-criminalized possession under .

HB 4002’s effective date was September 1, 2024. But for the year prior to the recriminalization law, OHA reported a 22% year‑over‑year decrease in overdose deaths.

On the street, cruel rhetoric cues policy. Call overdose-prevention centers “ideological,” and it becomes simpler to shutter them than to count the reversals they perform. Smear syringe services as permissive, and you can cut lines that prevent HIV and hepatitis C while claiming fiscal prudence. Mock “harm-reduction spending,” and you can bury the line item without ever debating the outcomes. From January 1, 2019 through December 31, 2022, NYC Opioid Prevention Centers (OPCs) demonstrated no significant increases in violent or property crime, 911 calls, or 311 calls for drug use after opening; Vancouver reported ~35% reduction in overdose mortality rates for the period before (January 1, 2001 to Sept 20, 2003) and after (September 21, 2003 to December 31, 2005) the opening of the Vancouver supervised injecting facility.

Inside healthcare systems, the script causes harm. Clinicians already practicing under surveillance and time pressure learn to avoid nuance: less motivational interviewing, fewer shared decisions, and more default suspicion. The clinical vocabulary hardens; patients pick up on it the way they would the weather. When language gets sharper, so do consequences—people disclose less, absorb less, and leave treatment sooner. NIDA’s guidance exists precisely to counter those effects.

Here’s the measurable part.

The Anti-Theatrical Fix: What Actually Works

The fix is anti-theatrical. Call things what they are: naloxone reverses overdoses, syringe programs prevent infections, and supervised drug consumption reduces death and connects people to care. That’s not a worldview; it’s plumbing. Use words that keep doors open. Person-first language is stigma hygiene, not a lifestyle brand. Judge policies by outcomes and timelines rather than outrage cycles. If the curve bends where capacity expands and supply is stabilized, then fund capacity and stabilize supply. Retire spin peddlers as culture-war props. Courts have even noted when “anti-woke” laws cross constitutional lines—“viewpoint discrimination is inherent in the design and structure of this Act.” (Honeyfund.com Inc. v. Ron DeSantis, et al., No. 4:22-cv-00227, N.D. Fla. Aug. 18, 2022)

We could even try a fascinating (or, perhaps, boring to some) experiment in courage: let leaders earn applause for actions that quietly work instead of things that loudly sting. Pay clinicians for patient-reported function, not for performing moral panic. Reward programs that shrink infections and deaths, not those that inflate arrest numbers. And when someone tries to sell you earplugs branded as “toughness,” ask to see the data, the denominator, and the deaths averted. If you need a slogan, Ron DeSantis already gave you one; it just proves the point.

None of this requires everyone to be “woke.” It requires us to be awake. The linguistic jujitsu that turned woke into a boo-word lets leaders score easy points while patients lose hard chances. You can see the toll in the quiet statistics, but you can also hear it in the voices that don’t come back including  the patient who won’t return after being called an unkind name; the parent who stops carrying naloxone because a lawmaker sneered at “harm-reduction spending”; and the person who overdoses in a locked bathroom because a supervised site was branded “ideology.”

Awake, Not Woke: A Clinician’s Bottom Line

Disclosure: Lynn R. Webster, MD, is a pain and addiction medicine specialist and serves as Executive Vice President of Scientific Affairs at Dr. Vince Clinical Research, where he consults with pharmaceutical companies. He is the author of the forthcoming book, Deconstructing Toxic Narratives–Data, Disparities, and a New Path Forward in the Opioid Crisis, to be published by Springer Nature. He is not a member of any political or religious organization.