Two Utah doctors caught in spotlight of opioid lawsuits
SALT LAKE CITY — Two Utah doctors who were among the most prominent advocates of using opioids to treat chronic pain are now entangled in a spate of lawsuits filed against opioid manufacturers in several states.
In one of the most high-profile lawsuits to date filed last week by the Ohio Attorney General, Salt Lake City pain researcher Dr. Lynn Webster and University of Utah anesthesiologist Dr. Perry Fine are named as part of a “small circle of doctors” with ties to the pharmaceutical industry who supported chronic opioid therapy in books, articles, speeches and educational seminars in the 1990s and 2000s.
The Ohio lawsuit does not name Webster or Fine as defendants but instead names them as part of a larger case the state is building against five pharmaceutical companies for deceptive marketing that downplayed the risks of prescription painkillers like OxyContin.
According to the CDC, Utah ranked seventh in the country for drug overdose deaths between 2013 and 2015. Approximately 24 Utahns die every month from overdosing on prescription painkillers, according to the Utah Department of Health. In 2015, 282 Utahns died from prescription opioid overdoses — about six per week.
Ohio, likewise, consistently ranks near the top of drug overdose rates.
The Ohio complaint alleges that drugmakers used “key opinion leaders” like Webster and Fine to spread statements about the risks and benefits of opioids, helping to fuel the prescription painkiller and heroin crisis responsible for the deaths of more than 3,000 people in Ohio last year.
“Our office believes the evidence will show that drug companies used front groups, official sounding communications and authority leaders to promote a message that is different from what would be on the warning labels,” Dan Tierney, spokesman for the Ohio Attorney General’s Office, said.
Webster and Fine are also named in a lawsuit filed by the city of Chicago as opinion leaders, but are not defendants in that case. They are named as defendants in a similar case brought by several counties in New York against pharmaceutical companies.
Both doctors objected to the claims in the lawsuits and said they did not downplay the risks of opioid use to patients or other doctors.
“Whatever claims are being made are absolutely false,” said Fine, who practices at the Pain Management Center at University of Utah Health. “That’s it.”
“Chronic pain is a very serious public health problem and … substance abuse and misuse are equally significant and public health problems. And my efforts as a physician have always been to follow my duty to optimize the health and well-being of people with illness or injury.”
Webster, who works as the vice president of scientific affairs at research organization PRA Health Sciences, called the Ohio lawsuit’s claims regarding his work “baseless.”
“I have probably, as much as anybody in the country, worked to try and prevent people from harm and all of my educational materials and lectures were about the risk of opioids,” Webster said.
Webster and Fine were known throughout Utah and the U.S. as prominent pain experts in the ’90s and ’00s.
Both have previously served as presidents of the American Academy of Pain Medicine, a doctors’ group. Webster also developed a risk-screening tool that was used in many states’ opioid prescribing guidelines, including Utah’s 2009 overhaul to make guidelines stricter.
The Ohio complaint claims that “key opinion leaders” like Webster and Fine were “selected, funded and elevated by (the pharmaceutical companies) because their public positions supported the use of opioids to treat chronic pain.”
Among other things, the lawsuit mentions a DEA probe that had targeted Webster in 2010, spurred by the number of patients in his former pain clinic who overdosed on opioids. The DEA closed the case without charges in 2014.
The lawsuit also pointedly criticized Webster for promoting a concept called “pseudo-addiction,” the notion that some patients who exhibit addiction-like behaviors may simply be undertreated.
In a 2007 book about managing pain and opioid abuse, Webster said that when faced with signs of possible addiction, “in most cases” increasing the dose to see if the patient needed more of the drug “should be the clinician’s first response.”
According to Andrew Kolodny, co-director of Opioid Policy Research at the Heller School for Social Policy and Management at Brandeis University, the concept of “pseudo-addiction” came into vogue in the 1990s as doctors began freely prescribing opioids.
“Primary care doctors were being told that true addiction is extremely rare,” Kolodny said.
But then those doctors would see patients coming back looking for more doses at higher levels. That’s where “pseudo-addiction” came in, Kolodny said. Under that theory, patients seeking higher doses, acting like an addict, were often not addicts at all. They were, rather, suffering from severe pain and needed higher dosage.
Kolodny declined to comment on any individual doctors, but he was sharply critical of the concept of pseudo-addiction.
“To tell doctors that if your patient looks addicted you should give them more?” he asked incredulously. “That concept must have killed many people.”
Webster acknowledged that pseudo-addiction “became an excuse sometimes to provide more medicine.” He also acknowledged that doctors had learned more about opioids over the past 15 years.
“There certainly was a time we thought we could eliminate pain and provide people a quality of life by giving them whatever we needed to,” Webster said. “And I think that we recognize that that’s not the case.”
But “I think today there is an attack on people in pain,” he added. “If they’re using an opioid, they’re stigmatized. If you’re prescribing an opioid, you are often accused of contributing to a huge social problem, and I don’t think that is fair.”
The plunge into using opioids to treat chronic pain occurred with very little research or forethought, according to Michael Von Korff, a senior investigator at Kaiser Permanente Washington Health Research Institute who researches opioid risk reduction.
“For nearly 25 years we were acting on expert judgment, rather than on science,” Von Korff said.
Von Korff views the mistakes as well-intended treatment, and he puts blame on institutions like the American Pain Society and the American Academy of Pain Medicine, on the industry which pushed to expand usage, and on the doctors who helped normalize it.
Von Korff cites a 1996 consensus statement by the American Academy of Pain Medicine and the American Pain Society on the use of opioids to treat chronic pain as example of how unscientific the field was when the epidemic began. 1996, not coincidentally, was also the first year that OxyContin was approved by the FDA.
Much of that 1996 statement reads like a strong plea advocating wider use of opioids for treat chronic pain and downplaying risks.
“Misunderstanding of addiction and mislabeling of patients as addicts result in unnecessary withholding of opioid medication,” the statement argues, adding that “there does not appear to be an arbitrary upper dosage level.”
“I tend to assume that people are doing what they think is the best interest of the patients,” Von Korff said. “The problem is that the research that should have been done wasn’t done. Meanwhile, the professional organizations were getting a lot of money from the pharmaceutical industry.”
Webster is still a major researcher for many pharmaceutical companies today. According to the federal government’s Open Payments database, Webster received nearly $100,000 in payments from pharmaceutical companies for speaking engagements and consulting fees in 2015, the most recent year available, as well as $1.4 million in associated research funding.
Fine received $15,000 in payments from pharmaceutical companies that same year, mostly for speaking engagements and consulting fees.
1 comment on this story Fine also previously served on the board of the American Pain Foundation, once the nation’s largest organization for pain patients. The foundation shut down in 2012 after reports came out about how much of its funding came from opioid drugmakers.
Fine denied that pharmaceutical companies have ever influenced his medical judgment and said that all professional societies he has been a part of sought only to advocate for patients and advance research into pain treatment.
“I’ve always practiced the highest standard of professionalism and followed the essential obligations of medicine: First, do no harm,” Fine said.
Filed under: General Problems
This really makes me angry! Now they go after the doctors who are advocating for pain patient! This just shows that they want to cover up their mistakes! The CDC Guideline are fraudulent and more doctors are stepping up to fight for the patients! We are rooting for you doctor Lynn Webster!! God bless you!
I would love to know who is paying for all these ,.”addiction commercial’s,?????I asked ,,I wrote them,,,no reply,,,curious though u look up thee advertisening company the cdc hired 1 year ago,,and it states the word,”phoenix,”next to the web address on top of page,,,anyone know who’s payen for all these addiction commercials?????maryw
And by the way, Pharmacy Steve … SERIOUSLY??????????
I hope these people are slammed with a defamation of character and frivolous lawsuit. I don’t know Dr. Fine, but I met with Dr. Webster at length. NOTHING COULD BE FURTHER FROM THE TRUTH. Dr. Webster used his own funds to do a 2-year study/documentary following chronic pain patients who were seriously injured, trying to bring light to a segment of society who were being destroyed by the CDC, FDA, Andrew Kolodney, PROP, and others out to destroy chronic pain patients and have been largely successful in doing so. When I met with Dr. Webster, I told him that based on my interactions with chronic pain patients, that if we ever got to the point where opioids were taken away from chronic pain patients, we’d see a wave of suicides like we’ve never seen before. He asked what made me say that. I told him it was based upon what I was hearing from hundreds of people who were currently declining due to decrease in meds which had kept them stable and functioning for years. Your article clearly states that Dr. Webster was cleared of any wrogdoing, so you’re throwing that in simply to discredit him. I am DONE with believing anythig I hear from one-sided reporters like you. Do your homework. Report the truth. Quit demoizing chronic pain patients. If you believe that the prescriptions written by doctors for documented illnesses and injuries where no other viable treatment options exist, you are living in a parallel universe. Anyone can file a lawsuit. It does’t mean it will be successful. The press is all over it when lawsuits are filed, but NEVER report a word when the lawsuit is thrown out of court. Before being blocked by Andrew Kolodny on Twitter, I sat and watched as he and his buddies bragged about their plan to fill Kolodny’s addiction beds at The Phoenix House. They discussed involuntary commitmet for chronic pain patients. One doctor, who was promotig a book about his stent in a drug rehab facility laughed and called it BS. When asked why he went if it was BS, he laughed and said because his license was on the line. Well planned and executed, Kolodny. You wedged your way into a position of power (due to your connections with Tom Frieden, then diretor of the FDA, and selected a group that you hand-picked for PROP to exeute your plan. You quickly cut ties with The Phoenix House to make yourself look more independent. People know you for what you are. We’ll all answer to a higher power in the end. I’ve got a clear conscience. I don’t have a dog in this fight. Only compassion and hope for the future for the millions of Americans you are sarificing under the pretense of reversing the heroin “epidemic”. Reporters report what they can find. I am urging this reporter to give equal press time when this lawsuit fails miserably.
Do u know if Klondike had any connectionist in the dea?? and twitter eh,,,,he’s on twitter????hear that people,,,the murderer Klondike bar is on twitter,,,im signing up,,,this whole thing is exactly like Pennhurst,,Eugenic etc,,,and ,”our” government fell for it hook line a sinker,,,,got a copy of those twitter comments???,,god if I had the money,,,i’d be sueing him personally,,,,and other things,,,,,,maryw
I repeat what others say, BULL CRAP totally f****** BULL CRAP! Do these idiots actually believe what they are spouting? Yes we need to file a lawsuit against them but to get into court you must have an attorney and that’s not likely to happen cuz they like their jobs and the big money they can make doing it and the government agencies who for reasons only they can comprehend have decided that opiate pain medication is the root of all evil would see to it that any attorney who tried to take a suit for us into court would lose their lucrative jobs! I haven’t totally given up hope but am losing more hope every day. We as chronic pain patients will most likely either have to learn to live with pain that no one should have to live with or die by our own hands. It’s wrong but it’s the way itv is. I don’t understand what has happened to compassion or to personal responsibility but neither are alive and well in today’s society! I am desperately searching for an alternative to treat my pain but it’s not looking good! I have recently moved to Oregon where mj is legal both medicinal a recreational but the only hope I have of getting my medication will be gone if I use ANY because it’s written in big clear letters in the new patient paperwork that the use of mj will be reason to deny opiates! How they can get away with such a ruling is beyond me! Pain relief/control is a thing of the past unless you are super rich and can buy your own doctor!
kiss pain management good bye??!!!!!!!!,,,wow,,,,,,,,,now if u speak up FOR THE USE OF MEDICINE to lessen physical pain,,your dead,,,,,wow,,,,,,,,,un-fu– believable,,,Reverse it,,,,file the same charges against the state of ohio/chi-town!!!!!!!now,,,today,,,not tomorrow,,,,,,un-f-believable,,,,forwading to my lovely aclu,,wtf is it going to take to stop this ,,,THEY WANT OPIATES GONE!!!!!,,,,,ii SWEAR,,, if i say what I really want,,,id be arrested,,,,if those 2 docs or any of those pharmaceutical need me to testify for opiate medicine,,,i am there!!!!!!!,mary
This is a ridiculous lawsuit. Always looking to place blame. Blaming opioid medication for the heroin epidemic. Blaming overdose on legal opioid medication. Why are the real statistics not being looked at? Addiction rate for chronic pain disease patients is very low, .02-.6%. 100 million Americans who have chronic pain disease. The deaths do not specify if the medication was for that person, if it was mixed with other drugs or alcohol, if it were illegal heroin or illegal fentynal. How can they possibly bring a lawsuit of any kind when none of these tests or toxicology is being done? Has the overdoses dropped since all these restrictions are being put on our physicians and opioids? NO… they are increasing.
What about the need for these drugs by the chronic pain disease patients? We have an incurable chronic disease. We are now the epidemic. We have medication readily available to us for our chronic incurable disease and we are being denied due to the cdc, dea, media etc. We are being labeled by the medication we need for our disease. WE chronic pain disease patients should file a law suit against the cdc, dea and government agencies trying to stop our physicians from treating us appropriately.
Absolute bullcrap. The government enjoys playing the blame game. Blame everyone and everything … except for the one who made the initial CHOICE to PURPOSELY crush a pill to snort or inject it. And before anyone jumps my tail – addiction starts with a choice and ends with a choice … choices that ONLY the addict can make.
I know the politically correct answer is to blame everyone but the addict, telling the addict that it’s not their fault, but there comes a time when we must address this with the truth. (In no way am I meaning to imply they deserve bad things or are bad people. They don’t and they’re not). However, when a person doesn’t follow directions when it comes to ingesting substances, bad things will most likely happen. It’s called common sense. Oh, let me introduce another important term that society has forgotten – personal responsibility.
And while I’m at it, somehow we’ve managed to elect little Beavis and Buttheads to run this country and have been doing so for quite a while. Speaking of Beavis and Butthead, they just had to get Kolodny’s OPINION (yes, his opinion is NOT the truth) in that article … Kolodny, get your head out of your ass and read this:
Pills, plants and drinks are NOT the “cause” of addiction (physical dependence is not addiction). If they were, then we’d all be hopeless addicts. Not only that, but the government would have to restrict or ban those fun activities like sex, gambling, eating, and shopping since a small minority develop addictions to these activities.
Let me repeat – The act of sex is not the “cause” of sex addiction. The act of gambling is not the “cause” of gambling addiction. The act of eating is not the “cause” of food addiction. The act of shopping is not the “cause” of shopping addiction. The substance(s) (and activities) of abuse and addiction are merely the main symptom of a complex issue which needs to be addressed.