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Christensen answers questions from his council as he testifies. He faces two charges of negligent homicide for allegedly prescribing the drugs that caused the overdose deaths of Gregg Griffin and Kara Philbrick-Lenker.

TOMMY MARTINO, Missoulian

HAMILTON — Dr. Chris Christensen testified for four hours Monday, and will continue on the witness stand Tuesday, as his negligent homicide and prescription drug trial continues in its fourth week.

An affable Christensen told jurors why he is such an ardent advocate for treating chronic pain, and spoke of the road that led him to the witness stand, where he was questioned Monday by defense attorney Josh Van de Wetering.

He decided to become a doctor by age 10, and wanted to be a general practitioner instead of entering the more lucrative specialist profession because he wanted to emulate the doctor he depended on while growing up.

“We needed a new generation of general practitioners that were more comfortable with various specialties and in underserved areas that could expand their repertoires,” Christensen said.

He practiced medicine in California and Wyoming, but it wasn’t until he began treating patients in Idaho in 1992 that he developed an interest in treating patients with chronic pain. He noted that as the mining and logging industries in the Silver Valley — Wallace and Kellogg, Idaho — died out, the able-bodied people moved to find jobs elsewhere. That left many of those injured in the dangerous professions behind, with the depressed economy providing little money to pay for treating their ailments.

“Some fell 30 feet down a mine shaft, had been electrocuted or had a tree fall on them and crush their pelvis,” Christensen said. “Many were unemployable with relatively pessimistic futures.”

He went to a conference on chronic pain at the University of Washington in 1994 with his wife, and began addressing the issue with his patients. But he said a portion of the medical profession in Idaho believed those patients often were “fakers and liars.”

That concept is understandable, Christensen said, since two people can break a leg and while one person heals well, the other can be in pain even though X-rays look fine.

“The testing, so far as we can do it, doesn’t always tell us what is wrong,” Christensen said.

Forest Tennant, a Los Angeles public heath doctor who has operated clinics for intractable pain patients since 1975, testified earlier Monday that in 1996, long-lasting, slow-releasing opioids were created in pill forms. That prompted the federal government to say it was acceptable for any doctor to prescribe them, believing the pills were less likely to be abused or cause addiction.

“That was a big mistake,” Tennant said. “After that time, doctors started prescribing opioid drugs as a first line of treatment. I was against this, but I was a distinct minority.”

Still, he said prescribing opioids became a medical standard, with the Physicians’ Desk Reference — the medical profession’s bible — not giving any warning or ceiling as to opioid dosages.

“That was between the physician and patient to determine,” Tennant said. “There was no single government reference, no single document, no single article until 2016 to tell doctors how far they could go.”

Meanwhile, a doctor in the Silver Valley left his practice, with many patients who were opioid-dependent. Christensen said that was because many doctors in the area were employed by the mines, and their primary responsibility was to get the patients well enough to return to work.

Christensen said working with those patients increased not only his sympathy, but his empathy as he realized his own father, who was an alcoholic, also was in chronic pain from neck injuries he received after his B-17 bomber was shot down in World War II and he was hit over the head with shovels to subdue him.

“I realized I grew up with a chronic pain patient,” Christensen said. “I realized in a very palpable way there were effects that untreated pain had on the dynamics of family and the social dynamics of young people growing up. I understood how it disrupts their quality of life.”

He took continuing education classes about treating chronic pain, the use of opioids, and the risks of addiction. He joined the American Pain Society and the American Academy of Pain Management. He moved to Montana in 2005, after his wife got a job with Marcus Daly Memorial Hospital in Hamilton.

“We began to give increasing credibility that we could take large groups exposed to opioids and see less addiction than what was predicted,” Christensen said.

But as Christensen took on more chronic pain patients, he also was taking on their highly complex cases, which Tennant said was beyond the scope of his or any other general practitioners’ capability. Yet that was the government’s standard of care at the time, and Christensen and other family doctors were in compliance with the government.

Tennant also said that put Christensen in compliance to standards in the 11 patients to whom he is accused of distributing dangerous drugs. Christensen also is charged with two counts of negligent homicide for two of his patients to whom he prescribed opioids and died from overdoses, and nine counts of criminal endangerment.

“By today’s standards, he wouldn’t be allow to treat those, but back in his day he is well within the style and standard of the country,” Tennant said.

In 2000, the United States Congress proclaimed 2001 to 2011 as the “Decade of Pain Control and Research,” to focus attention on the public health crisis of chronic pain. During that time, the pendulum of opinion on opioid use swung toward being more restrictive. In 2016, the Physicians’ Desk Reference backtracked on prescribed dosages, saying they should be limited.

“But from 2001 to 2016, it pretty much was anything goes,” Tennant said. “In this country, we have those patients — some in Dr. Christensen’s office — who tried everything, have been everywhere, and unless you can get into a special clinic like I have, those people are thrown to the wolves. Nobody knows what to do with them.”

Christensen’s Florence clinic was shut down in April 2014 after an investigation that allegedly showed he prescribed opioids to anyone who said they were in pain. He counters that he has thousands of patients, and the prosecution is focusing on 11 who he said either already were addicted when he first saw them, or needed the pills for pain. He also said he uses a wide range of approaches to treat pain patients, including physical therapy, herbal supplements and just spending extra time listening to his patients.

“I adopted the philosophy, expanded by our leaders in the 1990s and beyond, that if you took a chance on a chronic pain patient, you should be committed to them as long as you will be in practice,” he said.

The trial resumes at 9 a.m. Tuesday.

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