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Did Researchers Who Seek to Relieve Pain Contribute to the Opioid Epidemic?

It's not just drug manufacturers who are feeling the effects of major opioid lawsuits.
Oxycodone pain pills prescribed for a patient with chronic pain lie on display.

Lawsuits allege that pain research associations like the American Pain Society contributed to the opioid crisis.

It's been front-page news lately that the manufacturers of opioid painkillers—companies such as Purdue Pharma and Teva Pharmaceuticals—are facing lawsuits across the nation. States, cities, and tribes are suing companies for their alleged role in igniting America's opioid addiction epidemic. What folks may not know, however, is that it's not just drug companies: Pain research associations are also being sued. That's led to upheaval in the field that some say is deserved—while others worry the lawsuits will slow the very research that many hope will help curb addiction.

"I think there'll be less advocacy for patients, less advocacy for research, less advocacy for this specialty in general," says Edward Michna, a pain specialist at Brigham and Women's Hospital in Boston and a former board member of the American Pain Society, a professional group for pain researchers and clinicians. Michna, like other American Pain Society members I spoke to, noted that pain researchers are searching for non-addictive painkillers that could replace opioids and ways of treating pain that rely less on drugs. The society helps them share their ideas and improve their research.

Adriane Fugh-Berman, a pharmaceutical marketing researcher at Georgetown University who has been a paid expert witness in opioid lawsuits, is less convinced of the American Pain Society's value. "They do no good at all," she says. Pain scientists should start over, she thinks, and "put together a meeting or a group that does not take industry money." Without the subtle influence of industry funding at meetings, researchers might more readily come up with low-cost, non-drug treatments for pain, she believes.

The issue came into sharp focus earlier this month, when William Maixner, the president of the American Pain Society, announced at the society's annual meeting that there would be no conference in 2020. He said the society was in financial trouble, spurred by five years of declining membership and the costs of major opioid lawsuits. In his speech, of which Pacific Standard obtained a recording, Maixner called the suits "a grindstone around our neck."

In a phone interview, he added that the American Pain Society has received less sponsorship money from pharmaceutical companies lately, adding to the society's troubles. ProPublica has found that opioid companies began spending less on marketing to individual doctors in 2016, possibly because of negative attention to their connections to doctors. American Pain Society leaders have never directly told members that fewer industry gifts are contributing to their financial problems, Maixner says, but members should have noticed "the greatly reduced footprint occupied by sponsors" during recent annual meetings.

In a couple of lawsuits in which the American Pain Society has been named, lawyers called it and other medical organizations "front groups" for opioid manufacturers. Pain research groups received "significant financial support" from opioid-making companies and then "deceptively promoted the use of opioids for chronic pain": for example, through guidelines that encouraged doctors not to fear opioids, the lawyers write in suits on behalf of the International Union of Operating Engineers and the Intergovernmental Risk Management Agency. "Because of their seeming objectivity and non-profit, public service missions, their promotional activity carried greater weight and buttressed [opioid manufacturers'] own marketing."

Maixner disputes those claims. "We have always been at arms' length from pharmaceutical companies with respect to our guidelines and our policies," he says. "Never have we had the intention of interacting with manufacturers in this way."

Chuck Weber, a spokesman for the society, declined to tell me what percent of the group's funding comes from pharmaceutical companies. A congressional investigation has found that, between 2012 and 2017, the society received more than $960,000 from America's top five opioid manufacturers. According to tax documents publicly available on Guidestar, the society's net assets at the end of the year ranged from about $500,000 to $1.3 million between 2014 and 2017.

"We firmly believe that we are on the right side of the suits and that we will be released over time from these lawsuits," Maixner adds.

In the meantime, how should the society move forward? Michna worried the American Pain Society is in a "death spiral," and predicts many pain research groups will go bankrupt in the coming years. Maixner has several ideas for keeping the society solvent, including courting funding from companies that would seem to have fewer conflicts of interest with pain doctors, such as those that make lab equipment. Several members have considered Fugh-Berman's way: starting a new society themselves, without industry funding.

One early career researcher I spoke to, who asked to remain anonymous to speak freely about the American Pain Society's problems because she feared it could harm her future job prospects, found the idea of going independent appealing. "There's a lot of energy that comes with grassroots stuff," she says. Like others, however, she worried that, without Big Pharma, there wouldn't be enough money to put on expensive events like conferences.

Fugh-Berman disputes this: "The idea that we need the pharmaceutical companies to fund meetings or fund other things is just wrong."

It's true that very many societies for doctors and researchers get industry sponsorship, especially for conferences. Fugh-Berman struggled to name any group that didn't, although she suggested the Society for General Internal Medicine does not. (I wasn't able to independently confirm this before deadline.) That doesn't mean it's impossible, of course, only that any pharma-free biomedical research society would have to chart its own, new course. Under pressure from a national addiction crisis, the pain field may be poised to do just that.