Utah doctor defends concept of ‘pseudoaddiction’

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NORMAN -- A controversial Utah doctor defended the concept of "pseudoaddiction" Wednesday and blamed insurance companies for contributing to the nation's opioid crisis.

Dr. Lynn Webster testified as a witness for Johnson & Johnson and its subsidiaries in a Cleveland County District Court case where the state of Oklahoma has accused opioid manufacturers of helping cause the state's opioid crisis.

The Utah doctor has drawn much criticism for his support of the concept of "pseudoaddiction," which is the idea that a person who is exhibiting drug-seeking or other addictive behavior may not actually be addicted, but may be acting that way because they are not receiving high enough dosages of opioids to relieve their pain.

Critics say promotion of that concept encourages doctors to prescribe more opioids to patients who are exhibiting addictive behaviors, which can worsen their addictions and lead to overdose deaths.

Webster testified he believes the concept of pseudoaddiction is valid, but it is "not meant to give clinicians an excuse to just keep increasing the dose."

Doctors should always carefully evaluate and monitor their patients, he said.

Webster blasted insurance companies, saying that are "a major reason we have an opioid crisis."

Insurance companies only want to pay for drugs, not other types of therapy, and they only want to cover the "cheapest" drugs and those are the ones that are most dangerous, he said.

The state alleges opioid manufacturers engaged in false or deceptive marketing efforts that understated the risks of addiction and fatal overdoses, while overstating therapeutic benefits. From 2000 through 2017, there were more than 6,100 prescription opioid-related deaths in Oklahoma, state officials have reported.

Webster was not named as a defendant in the Oklahoma lawsuit, but has been sued along with pharmaceutical companies in dozens of other lawsuits across the country because of his role as a paid speaker for drug companies that were promoting greater use of opioids to treat chronic pain.

Taking too many opioids can cause death, but so can untreated or undertreated pain, Webster said.

Testifying by video, Dr. Webster recalled a situation where he insisted that one of his patients try to taper off on his use of opioids because Webster thought the patient was taking too high a dosage.

The doctor said he discounted his patient's complaints of continuing pain.

The man went home, wrote a note to his daughter and killed himself, Webster said.

"I believe there's always been an undertreatment of pain and today its worse than its been in a decade," Webster testified, citing a published estimate that as many as 170 million Americans may be experiencing chronic pain.

State attorneys have questioned the validity of a variety of numbers that have been cited over the years to describe individuals experiencing chronic pain.

Webster said he believes untreated pain has become an increasing problem because the U.S. has an aging population and many doctors are now afraid to prescribe opioids because of potential sanctions and legal ramifications.

Johnson & Johnson played three other video depositions in court Wednesday, including the deposition of a vice president of a company that manufactures the active ingredients for opioids sold by various pharmaceutical companies.

William Grubb testified in his role as a vice president for Noramco, a company sold by Johnson & Johnson in 2016 that supplied more than half of the active ingredient in opioids produced by a number of pharmaceutical companies during the height of the opioid epidemic.

Grubb said he didn't think his company was responsible for the crisis, because the federal Drug Enforcement Administration tightly regulates how much product his company can manufacture and how much each pharmaceutical company can purchase based on a determination of the medical need.

"We do not bear any responsibility, not even 1%, because we are working within a framework the government has provided us and we do not prescribe," he said. "We're making an ingredient."

Grubb acknowledged his company didn't have to produce as much of the active ingredients as the DEA allows, but indicated the company plans to continue to produce up to its limit.

Also testifying Wednesday were Lawrence Carter, an investigator for the state board that licenses Oklahoma medical doctors, and Richard Zimmer, an investigator for the board that licenses Oklahoma osteopathic physicians.

Carter testified the Oklahoma Board of Medical Licensure and Supervision has no specific policy regarding the number of improper opioid prescriptions a doctor would have to write before being subjected to disciplinary action, but said one could be enough to bring a doctor before the board.

The board has referred cases involving doctors to other agencies for potential criminal prosecution, but it's not a common thing, he said.

Zimmer testified the Oklahoma State Board of Osteopathic Examiners received 145 complaints against its physicians last year and about 175 the year before. He estimated less than half involved diversion or improper prescriptions for opioids.

Zimmer said the board has no specific guidelines on the number of improper prescriptions one of its physicians can write before disciplinary action will be imposed and the board does not refer doctors it has investigated to other agencies for potential criminal prosecution.

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