The American Pain Society may soon vote itself out of existence, blaming soaring legal costs to fight litigation that alleges the organization, along with medical associations, acted as “front groups” for opioid drugmakers that gave them financial support.
“It is with heavy hearts that we write to inform you that it is the recommendation of the Board of Directors that [[the] American Pain Society (APS) cease its business operations,” said an email the board sent to the society’s membership Wednesday.
“APS has been named as a defendant in numerous spurious lawsuits and is subject to numerous subpoenas … (and) was unsuccessful in its attempts to resolve these lawsuits without the need for what will no doubt be lengthy and expensive litigation,” the May 22 message to members said.
With an 11 to 1 vote, the APS board voted to recommend that its members approve the filing of a Chapter 7 bankruptcy petition, under which the group would dissolve with an independent trustee disposing of its assets.
The email said at least 10% of its 1,173 eligible members must vote, with a majority of those approving the bankruptcy filing by 11:55 p.m. CDT Wednesday, May 29, for it to go through.
APS spokesman Chuck Weber said that if members vote for the board’s recommendation, the organization’s monthly Journal of Pain, numerous research grants, a young investors fund, and the group’s annual scientific meeting would disappear or be taken over by other organizations. The 2020 annual meeting had already been cancelled; the group’s president recently reported that membership had declined by nearly half since 2014, and meeting attendance had fallen off markedly as well.
In shock
“I’m in shock,” said Steven Stanos, DO, a past president of the American Academy of Pain Medicine, and medical director of pain services at Swedish Health System in Seattle, when told about the board email Wednesday. “This is a great association that’s done a lot of great work for patients and pain research.”
The AAPM and the American Geriatric Society are also named as co-defendants in at least one lawsuit that filed against numerous drug manufacturers and distributors by the Illinois Public Risk Fund, the state’s worker compensation pool.
APS officials would not speak on the record about the specific reasons why professional pain organizations are being named as defendants in these lawsuits that primarily target opioid manufacturers such as Purdue Pharma, Endo Pharmaceuticals, and Johnson & Johnson.
But Robert Twillman, PhD, executive director of the now defunct Academy of Integrative Pain Management, said that trade organizations such as the APS are being named because opioid company money supported them, including his own, for years. And some outsiders believe the trade groups “were a front for their [opioid manufacturers’] marketing activities.”
“People outside the organization — some of them — had that concern but those inside the organization who saw what we were actually doing with the money didn’t have that concern. We advocated for the appropriate access for patients in need, but we also advocated for access to acupuncture and massage therapy and chiropractic and all the other things we have as treatments,” he said.
Pharma money dried up
With national public attention now focused on opioid overprescribing and the now-vilified guidelines that contributed to it, those sources of funding have dried up — either because the trade organizations now refuse it or because drugmakers stopped doling it out. That, along with declining membership, is what happened to the AIPM in January.
“Medical organizations were supported to some degree by pharmaceutical funding,” Twillman said. “And in the pain space, unfortunately, the vast majority of that money comes from opioid manufacturers. So when they started being sued, and part of the allegation was that they were supporting organizations like ours as a front for their marketing activities, a logical thing for them to do was withdraw their support.” In the case of his group, the AIPM, about $1 million, nearly half of its budget, came from pharma, he said.
One official familiar with the APS board deliberations, who declined to be named for this story, said this:
“Organizations like APS and the AAPM and others are being named in these complaints because they’re being accused of writing recommendations and guidelines favorable to the use of opioids and some claim those guidelines were supported financially by the pharma companies.”
But, he added, “any guidelines that were published were published on the basis of the evidence that was known at the time. Medical science changes, and something that was published in 2009 might not be as germane in 2019, given what’s known about these drugs 10 years later.”
Litigation purgatory
In a letter posted recently on the APS website, its president, William Maixner, DDS, PhD, noted the group has been named in several lawsuits against opioid manufacturers filed in Illinois and in California, now transferred to an Ohio Multi-District litigation court.
“Monetary damages are not the goal for the vast majority of these legal claims, and plaintiffs are currently NOT prosecuting claims against [the] APS, which means we’re in ‘litigation purgatory,'” Maixner wrote. “We are being kept on the sidelines while they fight other parties.”
However, the APS has had to respond to “several subpoenas or demands for information … [that] are draining resources — both time and money. It impacts our ability to secure adequate insurance coverage and diminishes our risk tolerance. Our communication and advocacy efforts have been thwarted because of our inability to speak freely,” he said.
What the APS may have genuinely contributed to harmful and fatal overprescribing is up for debate and judicial consideration. Some investigations, however, have concluded that the APS and like organizations share in the blame.
On May 22, in fact, the APS was specifically named in a report by U.S. Rep. Katherine Clark (D-Mass.) and U.S. Rep. Hal Rogers (R-Ky.), entitled “Corrupting Influence: Purdue & the WHO.”
“The American Pain Society and its global arm, the International Association for the Study of Pain (IASP), promote opioid use, especially for chronic, noncancer pain [and it] is an organization with longstanding ties to Purdue that were the subject of a Senate investigation in 2017,” the House members’ report said. “The investigation revealed that multiple organizations that claimed to be independent patient advocacy groups, including the American Pain Society, received significant payments from opioid manufacturers.” The report also charged that the APS was “affiliated with multiple prominent individuals with connections to the opioid industry.”
A past APS president, Dennis Turk, received “personal fees from opioid manufacturers,” the report said. Another past president and former APS board chairman, James Campbell, is “credited with first saying pain should be treated as ‘the fifth vital sign,’ which became a key component of opioid manufacturer-funded promotional materials encouraging higher prescribing rates.”
Another Congressional report, issued by the U.S. Senate Committee on Homeland Security & Governmental Affairs, “Fueling an Epidemic,” said that from 2012 through 2017, the American Pain Society received $962,724, with more than half of that from Purdue. It was one of 14 specialty groups that received nearly $9 million from five opioid manufacturers, including Janssen, Depomed, Insys, and Mylan.
A legal shotgun
Robert Wailes, MD, chairman of the California Medical Association’s board of trustees and a San Diego-area pain specialist, lamented the lawsuits, calling them “a shotgun approach to include as many defendants as possible.”
Practically speaking, he continued, they are merely after deep pockets of pharma, with no blame for most physicians or their organizations, and said the lawsuits are abusing the legal system.
“It is very, very costly to have attorneys represent you and be present long enough to get you dropped from any individual case. If you multiply this by scores of lawsuits in different venues the costs are really enormous.”
Wailes, who also is the AAPM’s representative to the American Medical Association, stressed that he was speaking only for himself rather than any organization he represents.
Others emphasized that if the APS does dissolve, it will be a shame.
“It would be a tremendous loss nationally for pain education and pain research,” said Rollin ‘Mac’ Gallagher, MD, editor of the journal Pain Medicine, the official journal of the AAPM, and the recently retired national director for pain management for the Department of Veterans Affairs. Gallagher blamed the opioid epidemic not on the APS or other specialty provider groups’ guideline advocacy, but rather that practitioners “were not trained to take care of pain appropriately.”
Added Beth Darnall, PhD, pain researcher associate professor of anesthesiology at Stanford University’s Pain Management Center, “It would be a tremendous loss for pain education and pain research. They’ve really been a go-to place for researchers, and clinicians.”
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