Top pain doctors face scores of opioid lawsuits

Nation’s top pain doctors face scores of opioid lawsuits – Yahoo Finance – April 3, 2018 – By  Roger Parloff

Four of the nation’s leading pain doctors, who spearheaded a medical movement to treat chronic pain with opioid drugs, have been named as co-defendants in scores of lawsuits filed by cities and counties against opioid manufacturers.

The lawsuits allege that the doctors allowed themselves to be used by manufacturers, as part of a false, industrywide marketing campaign, thereby helping to instigate the public health crisis that has led to more than 300,000 opioid-related overdose deaths since 2000.

If they were “used” by manufacturers, and the manufacturers were the ones pushing the “wrong” message, why are the doctors being charged as criminals?  

The key manufacturers named are Purdue Pharma (maker of OxyContin); Teva Pharmaceuticals (owner of Cephalon, maker of Actiq and Fentora); Johnson & Johnson (owner of Janssen, maker of Duragesic); Endo Health Solutions (maker of Opana, Percodan, and Percocet); and Allergan (formerly Activa, formerly Watson Laboratories, which sold Kadian).

The luminary doctors are

  1. Lynn Webster,
  2. Perry Fine,
  3. Scott Fishman, and
  4. Russell Portenoy.

Because they allegedly accepted tens of thousands of dollars from opioid manufacturers—for research, consulting, speeches, honoraria, and continuing medical education seminars—and led organizations that also received substantial industry funding, plaintiffs lawyers assert that their messages became tainted, and that they overstated the drugs’ efficacy and understated their risks in ways that were scientifically unsupportable.

The four doctors have asked judges to dismiss the accusations against them for failure to allege a legally recognizable claim.

I was also thinking that “influencing” is not a criminal activity, even if you influence people to do the wrong things – especially when it’s with good intentions.

Three of the defendant doctors—Webster, Fine, and Fishman—are defendants in at least 80 of the more than 430 lawsuits now pending in federal court, and in a couple dozen more in state courts, according to two plaintiffs lawyers.

In the lawsuits, plaintiffs lawyers refer to the four doctors as “key opinion leaders,” or KOLs, a term used by the marketing departments of pharmaceutical companies for especially influential physicians they seek to influence. The manufacturers are said to have used the KOLs for “unbranded” marketing, thereby evading the strictures of branded marketing, which is closely supervised by the U.S. Food and Drug Administration.

“Although some KOLs may have advocated for permissive opioid prescribing with honest intentions,” alleges one typical complaint, filed in the Suffolk County supreme court in Central Islip, N.Y., “[manufacturers] cultivated and promoted only those KOLs who could be relied on to help broaden the chronic opioid therapy market… The KOLs knew, or deliberately ignored, the misleading way in which they portrayed the use of opioids to treat chronic pain to patients and prescribers.”

Webster’s clinic raided, but never prosecuted

From 1990 until 2010, Webster was the CEO and medical director of the Lifetree Pain Clinic in Salt Lake City, Utah.

He is the author of The Painful Truth, a book published by Oxford University Press, and a documentary of the same name.

In each, chronic pain sufferers tell their stories, and discuss the difficulty they have getting opioid prescriptions filled because of doctors’ or pharmacists’ suspicion that they are drug addicts.

He is also a past president of the American Academy of Pain Medicine (AAPM), a professional society that received, plaintiffs allege, about $2 million from opioid manufacturers from 2009 to 2013. Plaintiffs allege that he received nearly $2 million in funding from Cephalon over the years, on top of money from Purdue and Endo.

Webster’s clinic was raided by the U.S. Drug Enforcement Agency in 2010, 

This is just like what happened to another luminary pain doctor: Forest Tenant.

but the U.S. Attorney declined to prosecute in 2014.

In other words, they left Dr. Webster in limbo for four years from 2010 to 2014. This probably left him unable to practice and earn any income.

The DEA is very good at finding targets from whom they can confiscate literally everything of value whether they are eventually guilty or not.

They are successfully scaring away anyone who is trying to help pain patients.

Perry Fine, a professor at the University of Utah, and Scott Fishman, chief of pain medicine at UC-Davis Medical Center in Sacramento, are also past-presidents of AAPM, and each has written influential articles, books, or treatment guidelines in the field.

Fishman chaired the American Pain Foundation, a patient advocacy group that, by the time it was dissolved in 2012, was nearly 90% funded by industry, including 50% by opioid manufacturers.

Portenoy, who rose to become founding chairman of the department of pain medicine at Mt. Sinai Beth Israel Medical Center, authored a seminal 1986 study that triggered a revolution in opioids prescribing practices.

Until then, the drugs were used almost exclusively for managing acute (i.e., short-term) pain in hospitals or assuaging the misery of terminal cancer patients. His study concluded that long-held fears of opioid dependency were overwrought, and that such drugs could be used to treat chronic pain, too, running little risk of addiction—at least in patients with no history of substance abuse.

Of course, this so still true! Links…

$8 billion in opioid revenue in 2012; $3.1 billion from OxyContin.

The idealistic doctors who led this movement were eventually handed megaphones by opioid manufacturers, like Purdue (which launched OxyContin in 1996). The companies helped raised the physicians’ profiles by funding their research, speeches, and CME talks.

At continuing medical education sessions of the period, it was often taught that the chance of a chronic pain patient developing opioid-dependence was less than 1%.

This claim is still in the ballpark,, but there is currently no research into any positive effects of opioids, so we pain patients are on our own in trying to prove they work for us.

Few would endorse that claim today—though some still do.

Why not?

The same low rates of addiction have always been found for pain patients without prior substance use disorder.

Only anti-opioid studies are being funded and they all work hard to find negative effects while completely ignoring the positive ones.

But by the early 2000s, as overdose deaths began to pile up—linked largely, at that time, to the abuse of OxyContin—skeptics noticed that the literature being relied upon for claims of low addiction risk was shockingly thin.

There cannot be truly long-term prospective studies of chronic pain because it would be unethical for patients not to be allowed relief. Then again that’s what’s happening now, and patients are killing themselves.

This opioid prohibition is like a terrible life-threatening experiment on pain patients receiving opioid treatment.

They are trying to hide the bias and cruelty of things by keeping the numbers of pain-related suicides quiet. But I suspect the grim truth will become obvious soon, as more and more opioid restrictions are taking effect.

When patients are asked to bear literally unbearable pain, the only option for them is to kill themselves. 

How many have to die before we are taken at our word when we say:

“My untreated pain is unbearable”

Portenoy was back in news in late 2012, when he told the Wall Street Journal, “We didn’t know then what we know now.”  The paper quoted him telling an unidentified doctor during a 2010 video interview, “I gave innumerable lectures in the late 1980s and ‘90s about addiction that weren’t true.” Still, Portenoy told the paper, he was wary of the “pendulum” swinging back too far toward irrational stigmatization of opioids, to the detriment of patients in severe need whom opioids could benefit.

Jane Ballantyne, a professor of anesthesiology and pain medicine at the University of Washington, says that, with the exception of Webster, she knows the defendant doctors well. (She is now co-editing the fifth edition of a pain textbook with Fishman.)

Ballantyne became concerned about the use of opioids for chronic pain after research by her unit, published in 2003, suggested that opioids “can make pain worse, not better,” and that patients were “struggling with dependence,” as she recounts in an interview.

Today she is president of PROP, a group seeking to cut back on the use of opioids to treat chronic pain.

Asked about the lawsuits’ accusations, she responds: “They’re friends of mine. I believe they acted out of passion to advance not only the pain care of people who might have been ruined by pain but also their own careers. And that’s normal. That’s what we all do.”

In the United States, she continues, for a clinician to gain stature through research and publishing, “you do need to take drug company money because no one else is going to pay for it.”

Yes, this is a critical point:

To research the benefits of any drug, the only ones who will pay for it are the ones making a profit from the drug.

So, the only ones who will pay to research pain and its alleviation by opioids are the opioid manufacturers.

“So what you can accuse them of,” she continues, “is: They probably did take more money than the average person does, number one. They didn’t question why it was so easy to. It was a lot of money. The other is: They didn’t question the scientific veracity of what they were promoting.

What is more difficult is: What was their intention?”

This article is contributed by Opioid Watch, an independent, nonprofit news service of The Opioid Research Institute. The Institute is funded by the Joseph H. Kanter foundations. The Institute does not accept funding from the pharmaceutical industry.

Opioid Watch is a service of The Opioid Research Institute, just started in January 2018

Original article: Nation’s top pain doctors face scores of opioid lawsuits

3 thoughts on “Top pain doctors face scores of opioid lawsuits

  1. leejcaroll

    https://www.propublica.org/article/two-leaders-in-pain-treatment-have-long-ties-to-drug-industry What bothers me are at least 2 of the docs not diclosing all their funding. And APS was reportedly 88 – 90% funded by phrma https://www.propublica.org/article/the-champion-of-painkillers
    I did not know they had dissolved. It is expensive to fund an advocay group but APF should not have relied on pharma there are plenty of other places from where Paul et al could have gotten their funds.
    (I also know a pain doc who lost his licese, suspended but last I saw still not returned after the length of the suspension for sexual activity with patients yet they found 5000 opoid meds in a dsk drawer, he said they were for patients who c ouldnt afford them yet his pain clinic was very very expensive. The law did not go afer him for the pills.
    We need to have someone nayone speak up looudly and often enough that they are heard. It isnot the chronic pain community who is to blame. Most docs are not to blame. (that being said we also have to stop trying to deny that some docs are indeed bad apples.
    I know my opinion is not the common one but as those who scream opoid epidemic go after all who use them we have to stop being the other side that say all are innoicent.

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      I actually agree with you: not all doctors that prescribe opioids are angels and I’m especially disgusted with the huge pain groups, like APS and AAPM (now AIPM). They went after money and the only ones giving money to pain groups seem to be opioid manufacturers. (I expect this is true of most special interest groups) But, they should have known this would compromise their message.

      I even mailed back a gift certificate for Starbucks that Zogenix gave me after I participated in a “roundtable discussion” about Zohydro. I was so happy and surprised when I received it, but then a sickening feeling came over me – I suddenly felt “bribed”, even though they never mentioned it before the discussion. I said positive things about their drug and then they sent me this “gift”. It was such a bummer when I had to send it back, but at least I remained free of their influence.

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  2. scott michaels

    This is a great opportunity. THESE DOCTORS AND LINE UP THOUSANDS OF PATIENTS AS WITNESSES FOR THE DEFENSE.
    ITS ABOUTTIMETHE PATIENT HAVE THOER DAY IN COURT. NO JUSRY IN THE WORLD WOILD CONVICT AND THEY WOULD DEMAND RWPAYMENT FOR ALL COAT BACK TOTJE DRS. I WOULD LOVE TO TESTIFY.. IS THE MEDICONE OR A LIFE CURLED UP I BED.

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