Long-Term Opioid Use Questioned at FDA Hearing

Recently, I’ve been reading and thinking a great deal about the use of prescription drugs for pain. Opioids are clearly the flashpoint for current debate.

From today’s MedPage:

Opioids used to be prescribed primarily for cancer pain and short-term relief immediately after surgery or an accident. But that changed in 1996, when the American Academy of Pain Medicine and the American Pain Society — organizations that get substantial funding from drug companies — issued a joint statement endorsing the use of opioids to treat chronic pain and claiming the risk of addiction was low.

Since then, drugs like OxyContin and Vicodin increasingly have been used to treat a wide array of chronic pain syndromes including low back pain and fibromyalgia, despite a lack of good scientific evidence to prove that their benefits outweigh potential harm when used long term. Opioids are also increasingly being prescribed to the elderly, often for chronic pain.

The Obama administration has called the current prescription drug abuse epidemic a “public health crisis” worse than the crack and heroin epidemics of past decades. In 2007, there were 28,000 deaths from prescription drug overdoses — five times the number in 1990. Those deaths were driven largely by the abuse of prescription painkillers. Painkiller abuse now matches abuse of illegal drugs.

“[Opioids’] increasing use has resulted in a clearly unacceptable increase in addiction, overdose, and death,” Douglas Throckmorton, MD, deputy director for regulatory programs at FDA’s Center for Drug Evaluation and Research, said at the meeting.

But the meeting didn’t focus on safety concerns with opioids; rather, it focused on efficacy and effectiveness, and attendees discussed the existing evidence to support giving pain patients opioids long term.