SEATTLE (Legal Newsline) - A pain specialist doctor called as a witness for the defense in the trial of three opioid drug distributors accused of causing an overdose epidemic in Washington State indicated on Wednesday that the majority of doctors did the best they could, even if over-prescribing pain pills.
“They were doing their best with the information then available,” Dr. David Tauben told the courtroom. “I don’t think the good faith was shared by all concerned. There were a few bad apples (diverting drugs into the wrong hands).”
Tauben appeared digitally via Zoom.
The trial in the King County Superior Court is being streamed live courtesy of Courtroom View Network.
Prescription drug distributors McKesson, Cardinal Health and AmerisourceBergen Corp. are accused of irresponsibly over-promoting and distributing opioid drugs to pharmacies and doctors' offices that led to hundreds of overdose deaths in the state. The Washington State Department of Health estimated 1,200 in 2020.
Distributors take pills from the manufacturers and supply them to hospitals, doctor’s offices and pharmacies. The most commonly shipped opioid drugs include OxyContin, Hydrocodone, methadone and fentanyl.
Washington State Attorney General Bob Ferguson is asking for $32 billion in damages to enact anti-drug programs, but a state victory could result in a much higher award when surrendered profits and penalties are added in.
Tauben, a University of Washington School of Medicine pain and drug prescribing specialist who is today retired, participated with other doctors in setting up guidelines for prescribing pain pills. He said it became clear by the year 2004 that increasing numbers of available opioid pills were driving up the overdose rate.
“Was there an increase in opioids during the period?” defense attorney Enu Mainigi asked.
“Yes,” Tauben answered, adding that the state was flooded with opioids. “They were readily available. It was our assumption there was a huge marketing (selling to) the doctors. At the time it was our impression that opioids were being driven by the prescriptions.”
Earlier evidence in the trial alleged that doctors became more apt to prescribe pain pills in the early 2000s than they had been during the 1990s, when the drugs were more often used for cancer and end-of-life conditions. The early part of the decade saw a dramatic rise in the use of opioids for “non-cancer” pain.
In 1996, the state legislature put into law new guidelines stating that doctors would not face disciplinary action for prescribing opioids for their patients.
“It was more permissible the prescribing of opioids?” Manigi asked.
“Yes,” Tauben said.
“Did the prescribers start prescribing more opioids?”
“Yes.”
Mainigi exhibited a chart that read, “The opioid crisis was initially driven by good faith and the best of intentions.”
The 1999 regulations were subsequently repealed and new regulations enacted by the medical community in 2011.
“Dose and duration (length of drug taking) became the critical elements,” Tauben said.
Tauben indicated that the rules changes were designed to provide doctors more guidance on how they should prescribe pain pills in a more sensible manner. He compared it to installing highway guardrails, off-ramps and road signage along a route.
David Ackerman, attorney for Washington State, asked if opioids have a role in treating pain.
“Yes,” Tauben said.
“What caused you to reevaluate prescribing habits?”
“There were a significant number of patients who were doing worse (taking drugs),” Tauben said. “They (patients) were impaired. I was an agent in their worse-life status.”
“Did the prescribing of opioids lead to that result?”
“I had a very serious reconsideration,” Tauben said.
“In 2003?”
“Yes.”
“Some patients were not better off?”
“Yes.”
“In what way?”
“Their pain improvement was not sustained,” Tauben answered. “Their ability to work and to be with family did not occur.”
Ackerman displayed a graphic that described the situation in the early 2000s as “unchecked and undisciplined.”
Tauben agreed at the time there were few limits on prescribing.
“There were no guardrails to prescribers,” he said. “I suggested that we needed to be more disciplined.”
“What time frame?”
“It was 1999 to 2004.”
Tauben added that opioids had become a de facto (pain) treatment.
“Was there an epidemic of prescription opioid misuse you observed in Washington?”
“Yes,” Tauben said.
Ackerman displayed a chart that said the state had seen a four-times increase in opioid related overdose cases and the number of deaths had doubled between 1995 and 2004.
When Ackerman questioned Tauben about his position that most doctors proscribing the pills had been acting in good faith, Tauben while agreeing had qualified it by adding, “not exactly.”
“What did you mean?” Ackerman asked.
“They (abusers) were getting them (pills) from other sources,” Tauben said. “There was fairly easy access. It was an amount unknown.”