A report from Human Rights Watch accuses Tennessee of regulating opioids to the point of depriving patients in pain. Along with Washington State, the analysis focuses on Tennessee because of its new prescribing regulations, which are considered some of the strictest in the nation.

In its 109-page report, Human Rights Watch interviewed patients who were involuntarily weaned off of high-doses of powerful painkillers. Tennessee’s new law doesn’t directly impact so-called chronic pain patients, but it seems to have had a chilling effect. Several tell the advocacy organization that their doctors feel pressure to lower everyone’s dosages.

Gail Gray of Celina, Tennessee, tells HRW that her primary care physician cut her pain medication nearly in half but still felt like he could get in trouble. So Gray was forced to a clinic an hour away, which she worries might be a “pill mill” since they only take cash.

“I’m not comfortable with this. I feel like he [my primary care doctor] has pushed me into doing something that’s not right, and I don’t want to break the law,” she said.

More: Tennessee Doctors In Training Mode As Nation’s Tightest Opioid Restrictions Take Effect

HRW also interviewed clinicians, like a nurse practitioner from Vanderbilt’s hematology department who tells of her difficulty with insurance companies denying heavy prescriptions for a sickle cell patient.

A doctor in Knoxville describes how a new state law requiring physicians to try alternatives before turning to opioids has resulted in risky decisions. At times, he’s recommended surgery as a first course of action, just to avoid flack from regulators.

“It’s really against everything I was trained to do, but it’s the will of the legislators and regulators,” Dr. Joe Browder said.

The state did not respond to the study, which was funded by the U.S. Cancer Pain Relief Committee, a nonprofit with ties to pain management and the pharmaceutical industry. But Human Rights Watch says its top recommendation is for states to just limit the unintended consequences of cracking down on opioid prescribing.