Pain Doc: “Physicians Can’t be Cops — We’re Treating Pain Patients”

Pain Doc: “Physicians Can’t be Cops — We’re Treating Pain Patients”

Lynn Webster, MD, FACPM, FASAM

Dr. Lynn Webster, is medical director and founder of the Lifetree Clinical Research & Pain Clinic in Salt Lake City, and president elect of the American Academy of Pain Medicine (AAPM).

Recently, the U.S. Senate Finance Committee began investigating financial ties between pharamceutical companies and non-profit pain organizations like the AAPM, which have advocated the use of narcotic painkillers.

Citing an “epidemic of accidental deaths and addiction” caused by opioid medicines, Senators Max Baucus (D-Montana) and Chuck Grassley (R-Iowa) sent letters to Purdue Pharma, Endo Pharmaceuticals and Johnson & Johnson claiming there was growing evidence that drug makers funded the pain organizations to spread “misleading information about the drugs’ safety and effectiveness.”

The letters ask for a detailed account of all payments to the pain organizations, as well as several prominent pain physicians. Lynn Webster is one of the physicians mentioned.

According to ProPublica, Webster has accepted over $110,000 from Cephalon, a pharmaceutical company, for consulting and research since 2009.

Editor in Chief Pat Anson recently spoke with Webster about the Senate investigation and the ongoing controversy over opioid medicine.

Are reports about the industry funding of pain organizations overblown?

I’m not going to say they’re overblown because any affiliation between industry and the medical profession has a potential conflict. I think that’s a fact. But that doesn’t mean all of the contributions from industry to professional organizations are contaminated. There are ways to filter out, to lessen industry’s influence in professional organizations. We cannot be influenced by industry. We don’t want to be influenced.

I think the senators don’t have all of the facts, they don’t have enough information. They’ve seen one side of it. I don’t want to dismiss the potential harm that’s been associated with the (opioid) medications. I’m keenly aware of the harm and at the same time I’m aware of the need for these medications to treat chronic pain.

Do you think there was over-prescribing of opioids and that it was promoted by industry?

Well, I don’t know about the promotions stuff. But I think that physicians, including myself, for a decade believed that there was very little harm associated with the prescribing of opioids and that, frankly, there was no upper limit to what we could or should give to individuals. That didn’t come out of industry, that belief, that philosophy. That came out of the field of medicine, where we just didn’t have all of the knowledge that we have today.

That philosophy does not exist anymore. And frankly, it stopped several years ago and we’ve been trying to address this balance, the conundrum between treating patients who need strong pain medicine versus those who should not have access to those medicines and could be harmed. We clearly know that there are limits to the amount. And some people should probably never receive an opioid.

There was a time, 10-15 years ago, we didn’t know that there were really as many people out there that probably wouldn’t benefit from an opioid. We know now and are working to try to help identify them through risk assessment, help stratify patients into low, moderate or high risk groups. And there are an infinite number of different risk groups.  Try to manage by monitoring these people better and try to detect individuals who are at increased risk of self-harm or may be contributing to the public harm by allowing their medications to enter the non-medical use.

You know, the other thing that is really not adequately addressed by the media is that there’s never a separation in the reports (between) those who are harmed from the medication they are receiving from their doctor (and) those who are accessing the medicine for non-medical use.

We see a lot of harm from opioids and certainly a lot of illicit use. In order for that to occur there has to be a diversion. Now there are many ways that can occur, but the most common way that happens is that patients who receive the medicine for a legitimate pain problem place it in the medicine cabinet or somewhere and then somebody takes it from them and steals it. Physicians can’t be cops. We’re treating pain patients. We need to focus on the health of that particular patient.

For a long time medicine in general, not the pain docs, but mostly dentists, surgeons and ER docs, have given more pain medicine to their post-trauma, post-dental work, post-surgical patients. Rarely do all of the people use all of the medicine given to them. And that’s where there has been a huge supply and cost to society, to insurance companies, to the federal government. Those drugs are available to other people to use for non-medical purposes and often are harmed by it.

We now understand that maybe we should be convincing those who are writing prescriptions to write less. The volume should be less because we don’t want leftovers.

Isn’t it true that it would be difficult to find any medical organization or doctor that hasn’t accepted an honorarium, free samples or even just lunch with somebody associated with the pharmaceutical industry?

Well, in recent years, a lot of that has been prohibited. There’s always a concern of industry’s influence over medical decision making and I understand that.  I think there’s some legitimate concern there. That is something we should be cognitive of.

But let me say this. We cannot advance our knowledge, we cannot interact amongst leaders in the field or scientists in the field, without having a forum to do this. It can’t always occur in the journals. That would slow down the advances in information enormously. So you have to have meetings and conferences. Meetings and conferences have been, for most part, supported by industry.

We can be critical of these relationships and I think we should be. And we certainly need to understand that. There absolutely always has to be full disclosure. But because there has to be a relationship with a funder from industry to the field of medicine doesn’t make it bad.

Do you think the controversy over addiction and the misuse of opioids has turned into a witch hunt of sorts?

I think if I was on the outside and I saw some of the harm that’s being created from the medications, certainly the expense, I would be very concerned too. But I would ask that everybody who is interested in solving the problem, look into the weeds, look into the roots of what is really being said and try to understand it so we don’t have unintended consequences.

Let’s be clear. There are 100 million people in this country who have chronic pain. I would guess about a third of them have moderate to severe pain. Less than a fraction of them are receiving opioids. Probably far more people in this country could benefit from good appropriate analgesics than are being harmed. That doesn’t mean we should ever accept harm from any of these medications.

I and others have been working hard at trying to solve this problem for more than six years, long before it came on the radar of the senators or before it came on the radar of the CDC. And in our state (Utah) we’ve been able to show about a 30% drop in unintentional deaths.

No patient who is harmed from medication is acceptable. And we’re working towards that, while at the same time trying to make sure that those people who can appropriately use the medicine and for whom it is appropriate have access.

There are a lot people responsible for the problem we have today.  Frankly, we’re all responsible. Our health care system’s responsible. The way in which we are addressing the unmet need of treating chronic pain. The villainization of medicines that are effective, but can also be harmful.

Nowhere else in medicine does it seem like we have to have as much emotion and weight of illogical thinking than in the field of pain medicine around opioids. A lot of people who get cancer, chemotherapy or cardiac drugs are harmed by them. They don’t become necessarily addicted, but they are harmed. We have something like 400,000 deaths a year from tobacco, we have 6,500 deaths a year in our military from suicide. We have as many suicide deaths in this country from pain as we do from many other contributing factors. So it’s a very complex problem.

Thank you, Dr. Webster.

Authored by: Pat Anson, Editor

There are 2 comments for this article
  1. James Hagen at 1:26 pm

    Thanks to both Mr. Anson and Dr. Webster for shedding light on some other sides of this issue. Dr. Webster insightfully describes a problem which has added to, but isn’t responsible for the current rage against opioid medications. Until comparison studies are carried out, often assumptions are made reagrding the effectiveness of this class of drugs from experiences of others.

    To expand this lack of knowledge, the fact that our current cadre of physicians report receiving between 0 and 2 hours of education on the treatment of pain while in medical school and residency. The only group of physicians who consistantly report more hours of training are those specializing in anesthesia.

    Funding has been so lacking by governmental agencies that most of the current peer-reviewed research literature in indeed funded by the pharmceutical industry. While that may seem a conflict, the treatment of people living with chronic pain in our country would be less well served without it.

  2. david at 12:55 pm

    Perhaps the public would be better served if Dr Webster would energetically advocate to Congress and state legislatures that all physicians have adequate education in pain medicine. Then the problems associated with pain medications would diminish. As Dr Webster well knows there is legislation pending in NYS and other states requiring doctors to have education in pain medicine- yet I don’t believe Dr Webster or the AAPM has actively supported specific pieces of legislation in this regard.
    To claim that pain specialists aren’t aware of the dangers of opioid medications- and lets not forget opioids have been in use since well before the time of Christ- is quite remarkable-and again it reflects that there is lack of adequate education in pain medicine- as even the specialists seem to lack much needed knowledge of safe use of medications for people in pain. Moreover pain specialists often know little beyond the latest edition of Bonica’s Pain Management. If knowledge will forever govern ignorance its time to set the bar much higher for both doctors and pain specialists.
    And I disagree with Dr Webster about the facts- we should not allow the AAPM or other organizations to pretend their occupational strategies are facts. The AAPM has their opinion like everyone else- and given the recent crises in pain care i believe it would be a mistake to take opinions of anyone as the definitive word in pain care. And i welcome Dr Webster to debate me openly on this issue as i for one believe debate on the issues should be uninhibited, robust and wide-open-and id like to encourage Dr Webster and the AAPM to engage fully a dialogue with all stakeholders in pain care.