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A leading expert in how to safely prescribe narcotics, Utah pain specialist Lynn Webster spent the past four years, as he describes it, "under the shadow" of an investigation into the overdose deaths of some of his former patients.
"If you receive a letter from the IRS that you're going to be audited, no one really questions your integrity," Webster said. "But when it's an audit by the Drug Enforcement Administration, people think differently, as if there must be something there or this wouldn't have occurred. You always have a sense that there is some guilt associated with it without having the ability to speak out or demonstrate otherwise."
The Utah anesthesiologist immediate past president of the American Academy of Pain Medicine (AAPM) was relieved this summer to learn federal prosecutors have dropped their inquiry.
"We have declined prosecution in that case and have concluded that we could not prove criminal wrongdoing beyond a reasonable doubt," said Melodie Rydalch, a spokeswoman for the U.S. attorney in Utah.
But still swirling are questions about the safety and long-term usefulness of opioid painkillers. Research suggests narcotics ease extreme, acute pain, such as that experienced after surgery, but evidence is mixed on its value for chronic pain.
Meanwhile, prescription drug abuse and opioid-related deaths remain an epidemic, despite regulatory efforts to prevent painkillers from being overprescribed.
And as a result, contends Webster, federal prosecutors feel pressured to do more. He said they have been going after physicians for "reckless prescribing," a tactic that makes doctors wary to prescribe strong medications and hurts those patients with chronic debilitating pain for whom opioids are the only source of relief.
"Doctors across the country are increasingly being inspected, reviewed and investigated; anyone who prescribes opioids," Webster said. "It's the only field in medicine where a certain class of medications exposes you to criminal acts. You can have people die from non-steroidal anti-inflammatories or blood thinners. Patients can take the wrong dosages and doctors can overprescribe, but only those who prescribe opioids are subject to criminal penalty."
Webster points to the example of Daniel Baldi, an osteopath in Des Moines whom a jury recently cleared of manslaughter and other criminal charges tied to the overdose deaths of some of his patients.
"When a physician stands trial for criminal charges for essentially practicing medicine, patients pay the ultimate price through inevitable abandonment by the medical establishment," Webster wrote in a June 4 guest editorial in The Des Moines Register. "Oftentimes these patients resort to a hopeless and dehumanizing search for medical professionals who are willing to help them."
Webster was a sympathetic witness in Baldi's trial.
The AAPM stood by Webster throughout his own run-in with the DEA, but he was uninvited from a Food and Drug Administration advisory panel and lost a book deal. "I don't care about a lot of that except that it was something that was challenging my integrity. That's the thing that hurt the most and still hurts," he said.
Nevertheless, he continues to advocate for people in pain, arguing against regulatory controls that could impede their access to medicine.
The 63-year-old has spent more than a decade writing and lecturing about safe prescription practices. His Opioid Risk Tool is still widely used by doctors to identify patients at risk for abusing narcotics.
But payments he received from opioid manufacturers as president-elect of the industry-backed AAPM came under scrutiny by the U.S. Senate Committee on Finance.
In 2010, Webster and a pain clinic he founded, Salt Lake City-based Lifetree, were targeted for investigation by the DEA.
Webster sold the clinic that same year but continues to work as vice president of scientific affairs for Lifetree Clinical Research Facility, which he started at the same location. The facility is hired by drug makers to test new therapies on patients, including drugs for pain.
News of the DEA raid didn't break until 2013 when Webster was quoted in the Milwaukee Journal Sentinel acknowledging that as many as 20 of his former patients had died of opioid overdoses. Those deaths, he was quoted as saying, had driven him to push for safer prescribing.
Later in an interview with The Salt Lake Tribune, Webster denied saying that, painting a more nuanced picture of the complex patients for whom he cared some of whom died, not because of treatment, but in spite of it.
"The treatment of pain is very challenging," he asserted again recently. "They come with complex medical problems, heart disease and neurological diseases, in addition to having pain. One-fifth have significant mental health problems."
Opioid overdoses are a serious problem, acknowledges Webster. But he said no one is talking about the other side of the coin stories of people like Ron Dickerson, who committed suicide in April because he could no longer live in pain.
The 75-year-old, a former airline mechanic, shot himself in the garage of his Sandy home. Already dealing with multiple health problems, he had just been diagnosed with stomach cancer, said his daughter, Lynette Dickerson.
"I don't think he saw a reason to keep going. He left a note apologizing but saying that he knew we understood," she said. "We had seen him horribly suffer for over 10 years and we suffered right along with him. It was awful. But we weren't upset with him, just upset with the situation, that more couldn't be done to help him."
Dickerson started seeing Webster in 1998 following a series of surgeries that failed to alleviate his back pain and neuropathy, his daughter said. "My mom said he was seeing all kinds of doctors who disregarded his pain. They didn't know what to do. He wasn't fitting into a diagnostic box."
The medications prescribed by Webster and his team at Lifetree initially controlled his pain, Lynette Dickerson said. But toward the end of his life, nothing worked, not the half-dozen medicines he was on, including oxycodone and a morphine pump, nor alternative remedies, such as acupuncture, she said.
If Dickerson illustrates the plight of patients in chronic pain, his story also shows what researchers are realizing: that narcotic painkillers are dangerous and insufficient.
There's some evidence they make pain worse.
Such treatments should be used selectively, with great caution and at low doses, said Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing.
Kolodny doesn't buy a "phony narrative" about prosecutorial overreach.
"The issue isn't that the DEA is going after doctors; it's that the medical community is realizing that treating patients in chronic pain with high doses of narcotics isn't a good idea," he said.
Until drug manufacturers develop safer medicines, however, patients are left wanting.
"My dad said that if the meds weren't alleviating his pain and would interfere with what little quality of life he had left, he didn't want them," Lynette Dickerson said. "But I wish they could have given him more. I didn't understand what there was to lose. Pain is subjective; you can't dictate how much pain a person is in or how much pain medication they need."
Fatal overdoses are slowly rising again
Poisoning is the No. 1 cause of injury-related death in Utah, driven primarily by fatal prescription overdoses. The problem was first reported by the state's medical examiner in 2004, after which drug deaths continued to soar. Health officials credit an awareness campaign for a decline in deaths in 2008. But funding ran out and drug deaths have started to inch up again.
2006 • 308
2007 • 371
2008 • 321
2009 • 306
2010 • 278
2011 • 306
2012 • 323
Source: Utah Department of Health