DEA Ends Investigation of Pain Doctor
In 2013, it came to light that three year’s earlier the Drug Enforcement Administration (DEA) had opened an investigation of then-president-elect of the American Academy of Pain Medicine (AAPM) Lynn Webster, MD, related to overdose deaths at Dr. Webster’s Lifetree Pain Clinic in Salt Lake City. [Editor’s note: Pain Medicine News was one of the news publications that reported the story.] Recently, the U.S. Attorney for the District of Utah declined to pursue charges, effectively ending the investigation. Pain Medicine News spoke with Dr. Webster, now immediate past-president of the AAPM, about his four-year ordeal.
Pain Medicine News: Dr. Webster, thank you for speaking with us. Let’s start by asking what ran through your mind when you first found out the DEA investigation was over?
Lynn Webster, MD: Relief. Not for me alone, but for my family and friends, who were supportive throughout this, and for my dedicated professional colleagues of more than 15 years, who treated a majority of the patients at the clinic during the period leading up to the DEA visit. This dark shadow hung over us for four years, and we had no way of knowing when—or even if—it would end. My attorney told me that there is usually no notice of an end to such an investigation. It can linger for the rest of your life, leaving suspicion of possible wrongdoing. I was always confident that our clinic had complied with the law and did the right thing. But, these days, that doesn’t protect anyone from an allegation of wrongdoing. So, we are thankful that a period was placed at the end of our story, allowing all of us from the clinic to move forward.
PMN: You recently wrote an opinion piece on the prosecution of pain doctor Daniel Baldi, MD (Pain Medicine News August 2014, page 1). Can you discuss how your personal situation over the past several years has shaped your interest and stance on physician prosecution?
Dr. Webster: My personal experience alone doesn’t necessarily shape my view. My views are formulated by what is happening in our field to my colleagues and our patients. The pressure to reverse the prescription drug problem has resulted in calls for stricter policies and more law enforcement. We should all be aware that there are unsavory physicians who dispense pills for profit without a legitimate medical need. Crossing the line in this manner has disrupted the ability of real doctors to treat patients with real pain when opioids are involved.
Physicians practicing in good faith who use opioids to treat some types of chronic pain face negative judgments, literally and figuratively, if a death occurs in their practice. This is unlike any other area of medicine. In some cases, the line between civil liability and criminal behavior has been blurred, in which clinical judgments retrospectively can be viewed as reckless and with willful intent to cause harm. Even a bad outcome without evidence of error can be investigated or prosecuted criminally. Ultimately, injustices such as these pose serious threats to people with chronic pain. Today, many physicians refuse to risk treating people in pain with opioids, even in cases where other therapies have failed or would be ineffective. A vocal contingent opposes prescribing opioids to patients with chronic pain, inexplicably unless the patients have cancer. I wish they would first listen to the stories of people who are crying for help and who have no clinically viable alternatives. It is too infrequent that policymakers, regulators, members of the press and government officials ever express concern for these people. That saddens me.
PMN: Critics have called this discussion of physician prosecution a “false narrative.” What is your response to that?
Dr. Webster: If you mean that it is false that there may be overreach by some regulators and prosecutors, I would say the facts state otherwise. Look at the case of Daniel Baldi, a doctor of osteopathic medicine and a pain physician in Des Moines, Iowa. He was recently charged with nine counts of involuntary manslaughter in patients who died of overdoses, complicated by multiple factors that included worsening medical conditions, medications prescribed by others and the co-ingestion of illicit drugs. In one case, Dr. Baldi had not seen the patient for months leading up to the death; in another, Dr. Baldi had only seen the patient once. However, the common denominator was that each patient had been prescribed opioids. The deaths were tragic, but the charges were unconscionable. The judge dismissed two counts, and the jury acquitted him of the rest. Regardless, Dr. Baldi’s career and finances are ruined, although it was clear in court he had practiced in good faith and did all he could to help his patients. Other physicians throughout the country are being forced into plea bargains because they can’t afford a defense. Aside from prosecution, regulators target “high prescribers” for investigation without sufficient context to evaluate the type of practice they run or the patients they treat. Actions like these clearly create a chilling effect. There is no false narrative.
PMN: You were the subject of a CNN story by Dr. Sanjay Gupta last year. The story centered around the deaths of two former patients from your clinic. Do you feel vindicated given that the U.S. Attorney declined the case?
Dr. Webster: Vindication implies that I was accused of wrongdoing. I was never accused of any wrongdoing, but when the DEA makes an inquiry, the implication is that there is something fishy and the perception of wrongdoing takes root. As a physician who has treated people in pain all my professional life, I always grieved for patients we treated but died. The fact is that some patients at our clinic died in spite of their treatment, but not because of it. This underscores the complexity and, sadly, inability of society to address the crisis of chronic pain.
As for CNN, I do not take issue with them producing a story for national consumption, but how they did it. The processes, by which they collect, analyze, verify and double-check the facts calls into question the network’s professionalism and journalistic integrity. I’ve made some of the inaccuracies in their story known to them and they’ve acknowledged this in correspondence with me. I did not participate in an interview with CNN, and I had no obligation to participate. However, that does not relieve CNN of its obligation as journalists to ensure their stories are free of error, bias and guesswork. This they did not do.
PMN: You have long said opioids need to be replaced as viable treatments for pain. Where should we go from here as a society to make that happen?
Dr. Webster: This is true. It would be morally reprehensible to abandon our societal obligation to treat mankind’s primal enemy: pain. There is controversy now about how many people in America actually suffer from chronic pain. Regardless, pain is the No. 1 reason people visit a physician. It will take time, but it is imperative to find safer and more effective alternatives to opioids. Not only because of the politics surrounding opioids but because, as medications, opioids are not effective enough and cause too much harm and grief. As a country, we should invest heavily in better therapies because of the prevalence and financial cost to society of untreated pain and addictions. We need a short-term strategy and a long-term strategy. In the near term, we must increase access to effective alternative therapies, which exist but are too seldom covered by insurers. Every time a regulator complains about the harm from opioids, he or she should also offer to support making available effective alternatives. We need guaranteed minimum insurance coverage for pain therapies. We also need better education about the risks and benefits of all treatment options, not just opioids. In the long term, we need Congress to create incentives for industry to develop safer and more effective therapies. We can do better if we have the will.
PMN: What do you look forward to accomplishing going forward?
Dr. Webster: My mission during the four years of the investigation was the same as it has always been: to help people living with pain and to prevent opioid abuse and overdose deaths. Going forward, I plan to adhere to that core mission. I agree with the Institute of Medicine that we need a cultural transformation. Access to appropriate and safe pain treatment should be viewed as a human right—a civil liberty. I am working on a television documentary profiling the lives of people in pain, which, tentatively, is planned for national broadcast in fall 2015. I am also working on a book. It is not a book about how to treat pain or the politics of pain. It is an experiential journey with some of the people I have treated. Their stories, the documentary and efforts to promote the National Pain Strategy through the National Institutes of Health is where I will invest much of my energy for the next couple of years. Then I will see where we are. I hope it’s a better place.
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REFERENCES
http://www.painmedicinenews.com/ViewArticle.aspx?d=PRN&d_id=86&i=September+2014&i_id=1100&a_id=28114
Dear Lynn —- I am so happy to learn that this nightmare is over. Please know that the entire pain community, and those of us who support it, were always behind you 100%. I think of all the contributions you’ve made to better pain management. This field is better because of you.
THANK YOU for all you do !
chris
Yes … The DEA is inflicting pain on people with real pain!
Since first injuring my spine about 15 years ago and having hardware failure which no one seemed to find!!! I finally found myself in such extreme pain I went to ER 9 nights in a row before a doctor agreed to do an exray if I agreed to a drug test!
I have no idea why no one found these broken screws earlier but one thing I did know was something was terribly wrong!
There was nothing anyone wanted to do about the broken screws because they said the chance of leaving me a quadraplegic was too great since the screws are in my cervical spine!
Since then I have been diagnosed with Interstitial cystitis, DDD, Osteoarthritis, Osteopinia and all sorts of problems with my spine which cause me a great deal of pain on a daily basis.
I can not stand or walk for more than a few minutes unless I take extra pain medication which I had when I needed it for a long time.
I am now 59 years old and have never once had to be treated for taking too much medication. I do not drink, smoke or do any type of drugs. I also have no criminal gistory!
However with increasing pain; and doctors afraid of prosecution, my breakthrough pain medication has been cut by 75%. I can feel the harm that this is doing to me because I no longer have the ability to go for a walk or stay on my feet. It seems like these changes have made my pain even worse when I try to make myself something quick to eat before going back to bed!
This is not living …. they took that away from me two years ago. I can see and feel the changes this has cost me in just two years!
If I don’t find a way back very shortly I know there will be no way for me to
put myself back on a road that will not lead to my complete destruction.
There is a well known saying “if you don’t use it you will lose it.”
I have for many years had to plan my day around my pain but their is not much planning anymore … Just Pain!
How long do they think that those of us that are in this kind of pain without the ability to even take a walk will endure … especially when we know there is a medication that helps us …. but everyone is now afraid to treat us with it!!!! ?
Dr. Webster, I am a woman with a defective spine, it is a congenital deformity.
For sixteen years I have been prescribed such high doses of opioids that three times I had to see the doctor for a voluntary dose reduction. The first drug Morphine IM was reduced one hundred percent, I stopped taking it. The second drug Fentanyl l reduced by seventy-five percent. Recently I decided I would like to see if I can function on less oxycodone and still survive the pain.
I was told not only would I be reducing my dose but that I had to be reduced to under ninety mg MED.
That is terrifying! It also is odd. The architecture of my lower back is so strange and painful that the local doctors gathered to brainstorm and try to help me. With sad eyes a surgeon told me that all they could do for me is control the pain.
Now the same doctors who told me it was certainly understandable why I was in so much pain and that my back is a mess are saying that that my back is fine and I should be able to get pain med doses under ninety ME.
I have been deceived in other ways also. Telling me that pain meds don’t work on chronic pain. It seems to me that would mean that they don’t work on acute pain either.
I promise you I was never asked to decide my pain medication doses. Now having had such large doses for so long the dose I am at now leaves me struggling to get up and walk. The craziness is that I am now in too much pain to do my regimen that I have done for the past twelve years. My regimen includes most of the alternate therapies doctors are asking patients to start doing. The less than therapeutic dose combined with no regimen is making me insane with pain.
Let me be clear. I have never had an issues with the medications, I keep them in a stationary safe so only I have access. I feel have a social responsibility to take urinalysis, sign contracts, use one pharmacy, etc. Civil liberties violated probably. Yet the benefits to society and keeping people safe is worth it. What a nice incredibly small sacrifice.
I can tell you that I have never had my pain specialist educate me regarding any of the dangers of opioids. I have never talked to any pain patient in sixteen years that has been educated by their pain specialist.
I hope this mess is fixed soon. I am a widow raising two little girls whose parents abandoned them. Not having my pain properly treated has seriously impacted their lives in a very negative way. They don’t deserve this and neither do I.
Thank you for any help you can give.
Kim McCormick
Dear Dr. Webster,
Thank you for your work on pain management. I am writing to request permission to use your tool Opioid Risk Tool-2 to be delivered for completion online outside of visit time by patients using our CHADIS system. We are physicians on staff at Johns Hopkins but this is not a Hopkins project.
CHADIS is a platform that delivers over 300 tools, almost all open source, for online completion when assigned by a clinician. The patients can complete the tools on any internet connected device includin tablets and smartphones. The clinician sees the results instantly scored and linked to decision support. Each patient has a Care Portal with patient-specific education and local and national resources populated from questionnaire results, clinician selection or free text search by the patient. CHADIS is in use in 48 states by over 60,000 patients per month and by 3000 clinician users. The use of CHADIS is free to patients and at a nominal annual fee to clinicians.
We hope you will give us permission to use this tool in CHADIS. If there is someone else I need to contact please let me know.
Thank you.
Barbara Howard, MD
Dr. Webster,
Thank you for producing the very powerful documentary, “Tpainful truth”.
My husband committed suicide on October 11,2016. He was a chronic pain patient (interstitial cystitis) . His PCP ( the only dr who would write opioids for him) abruptly abandoned him. He suffered excruciating agony for 49 days and no one would help him. This is becoming a frighteningly common occurrence with chronic pain patients, as you know. It is such a comfort to the families of these victims that health care professionals such as yourself are shedding light on this tragic epidemic. Again, thank you from the bottom of our hearts. From the family of Douglas Hale
Do the DEA and other authorities want people in chronic pain to die by suicide due to loss of opioid treatment and resulting inhumanely painful conditions? Will insurance pay for these “alternative treatments”? Do people actually think that the drug problem will be solved by taking appropriate meds away from people who have taken them responsibly? Go after the crooked docs and dealers, not rightful patients and honest doctors. Again, this country is throwing the baby out with the bath water.
First of all, I highly respect you Dr. Webster for pushing through what must have been four difficult years, and not abandoning your practice and patients. You are a man of great integrity, and I agree with you in that we need short and long term solutions for pain control to compliment, and someday replace medication.
Re: The State of Pain in 2018
Sadly, long term pain patients are primarily the citizens of our free country paying the price for doctors without morals and street drug abusers. Those of us who have been seeing a pain mgmt specialist regularly and following the rules set forth in our opiod contract should not, according to the CDC, have our pain medicine reduced because of the recent push to cut opioid sales. We should still be able to receive the medicine our physicians have conscientiously prescribed.
The recently updated guidelines are just that, Guidelines for doctors and pharmacists, and it’s one size fits all, which is why it can’t be more than a guideline as we all have different diagnoses for our pain. For some reason, almost everyone is turning the word guideline into directive, breeding unnecessary fear, and providing an opportunity for our medicine to truly be cut. Do the research, and tell everyone you know. Fight back. The only way to get the facts out is through word of mouth, or social media in today’s speak.
From what i have recently read via the web. The cdc now plans to build safe houses for heroin users, give them clean needles a bed and a nurse!!!!!!! What has happeded to our country??? They are backwards!!! They are condoning the use of heroin! Another country even gave out free heroin….twhen is the insanity and ignorance going to stop? Janelle abbott
I have knee pain and even when i lay down my knees still throb in pain. Arthritis runs in my family. My brother started out with juvenile arthrits. My parents thought he would grow out of it but it went straight to rheumatoid. Only age 10 and he was in so much pain. They prescribed nsaids. Id hear him crying through the bathroom door from all the ulcers he got. He passed away in 94. Now i, his sister is suffering and although not as bad as he had it. The joint really attack your quality of life. Thank you dr. Webster for making this documentary possible. I pray it brings awareness to lawmakers.
What BURNS ME is that our GREAT country is building “safe houses” for heroin users!! With those, heroin addicts are able to shoot up, get high and nod off, with nurse supervision and free supplies!! And our GREAT country is taking chronic pain patients (cpp) off of their medication, and offering NO alternatives!! Doing so is TAKING AWAY CPP’s QUALITY OF LIFE!! Being left to not be able to work, take care of their kids/families, go on outings…walks, parks etc.
Is that NOT completely WRONG??
We are not in the OPIATE CRISIS!!
We are in the IGNORANCE CRISIS!! THANK YOU to ALL OF YOU who are working to help the CPP’s!! Looking forward to watching the documentary!!