Another Medal of Irony: Dr. Lynn Webster, MD

Dr. Lynn WebsterMedal of Irony Dr. Lynn WebsterWell, I may have found another “winner” of the Medal of Irony Award. Remember that post I published in July 2013 about one of the country’s leading pain medicine specialists, Dr. Lynn Webster. There’s a CNN story about a pain medicine clinic he ran for over a decade in Salt Lake City where two patients who were being prescribed opioids and other medications for chronic pain management died of what might have been accidental overdoses. Malpractice lawsuits about a lack of oversight of prescribers at the clinic have been filed by the families of the patients who died.

It’s not yet clear what role Dr. Webster, President of the American Academy of Pain Medicine and a leading expert in opioid pain management, had, if any, in the deaths. The clinic he ran until 2010 is the focus of an ongoing Drug Enforcement Agency (DEA) investigation.

As a consulting psychiatrist I sometimes see the unfortunate consequences of the difficulties inherent in managing chronic pain with opioids. It’s too easy to blame doctors for alleged irresponsible prescribing and too easy to blame patients for abuse of prescription pain medications.

And yet, the buck has to stop somewhere, because it’s also too easy to say “It’s not my fault because I don’t prescribe opioids” or “It’s not my fault; I’m not a pain medicine specialist.”

It’s not my fault, but it’s my problem. One approach that psychiatric consultants can take is to call and notify local prescribers about their patients who’ve overdosed whenever critical care unit intensivists call for consultation regarding patients who’ve overdosed on prescription pain medications. I’m a great believer in the principle that the left hand should know what the right hand is doing.

The last line of my post in July are also chillingly ironic, “It isn’t just about addiction. It’s about physician accountability for prescribing painkillers.” You don’t “win” the Medal of Irony Award.” It is conferred on the unlucky and the unwary.

And especially in this case, there are no winners…only those who grieve.

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Comments

  1. I don’t like legal requirements as a substitute for best practices or clinical guidelines. I like prescription drug monitoring, urine toxicology, and treatment contracts because I think they are a rational approach to prescribing opioids. I think the physician and patient embarking on this treatment plan need to both fully acknowledge the risks for potentially modest benefits at the outset.

    Following the politics of this issue for the last 20 years it is obvious to me that there are always political interests out there who are ready to scapegoat physicians for a problem that they profess to be able to fix. At first it was that physicians were not treating pain aggressively enough and they were “confused” about addiction, dependence and tolerance. Now that we have a full blown “epidemic” of opioid overprescribing, physicians are the problem again because they are overprescribing highly addicting compounds. Politics is never a good solution to address problems in medical practice.

    At some point physicians are going to wise up to these political agendas (MOC?) that a scientific or legitimate moral basis – but I don’t think it will happen in my lifetime. Physicians as a group are just too politically naive.

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    • Did you mean in your last sentence: “…that lack A scientific or legitimate moral basis…”?

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    • I just saw Dr. Sharon Packer’s Psychiatric Times article, “The Top Five Psychiatry Events of 2013”. It’s in the December 2013 issue.

      One of the top five is the New York State I-STOP (Internet System for Tracking Over-Prescribing) regulations in effect since August 2013. Prescribers now have to check the state database (essentially a prescription monitoring program, I think) before prescribing controlled substances, including opioids but also other psychiatric medications such as amphetamines and benzodiazepines.

      What do you think about this new legal requirement?

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  2. Jim.

    I think the same thing drives the overprescription of opioids as the overprescription of antibiotics and that is unrealistic expectations. That is at least initially, but in the case of opioids if you are in the high risk group you also have the transition from positive reinforcement to negative reinforcement and taking the drug to avoid withdrawal. The physician accountability question is also an interesting one. One of the key elements is the physicians ability to manage the relationship with the patient including the patient’s unrealistic expectations (in the case of chronic pain) and set limits on demands for more medication. Physicians have widely variable abilities to do this and in some cases adopt the stance that they are the only ones interested in alleviating the person’s pain to rationalize their prescribing patterns.

    In this area of subjective medicine, psychiatry has a lot to offer primary care physicians and even pain specialists on keeping things on track, There also structural approaches like the NICE guideline for neuropathic pain that are very useful.

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    • I think unrealistic expectations are a factor. Do you believe physicians should be required by law to screen and monitor their patients by using prescription monitoring programs?

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