Should older adults use powerful narcotics for ongoing pain relief?
This is a much-debated topic in geriatric circles. Last week, it burst into the public sphere with an article in the Milwaukee Journal Sentinel and MedPage Today by John Fauber and Ellen Gabler.
Their story focuses on a 2009 recommendation by the American Geriatrics Society that physicians consider prescribing opiates more often to seniors with moderate to severe pain.
Potential conflicts of interest may have compromised the Geriatric Society’s guidelines, Fauber and Gabler discovered. Five of 10 panel members who prepared the report had financial ties with opiate drugmakers and a sixth member began serving as a speaker for a drug company in the following year.
In another disturbing finding, Fauber and Gabler reveal that a pain guide endorsed by the Geriatrics Society and funded by an opioid drugmaker highlighted benefits of narcotics while downplaying risks – the potential for addiction, cognitive problems, overdosing, falls and fractures, and the enhancement rather than diminishment of pain.
“None of these side effects was included” in the document; instead, it claimed that “opioids allow people with chronic pain to get back to work, run and play sports,” they write.
The Geriatrics Society told the reporters that it stands behind the guide and is “deeply concerned that public policy may create barriers that will limit older adults’ access to pain medicine.”
In a sidebar, Fauber and Gabler examine a related issue in this controversy: the contention that alternatives to opioids – common over-the-counter drugs such as Aleve, Advil and Motrin – can have more deleterious health effects than narcotics.
The 2009 Geriatrics Society guidelines highlight this point while referring to serious internal bleeding sometimes associated with ibuprofen and naproxen. But Fauber and Gabler found that the number of bleeding-associated deaths from over-the-counter pain relievers was “vastly overstated.” Even the researcher who arrived at widely cited estimates said the number was wrong.
That throws into question the argument that opioids should be used instead of nonsteroidal anti-inflammatory medications, which are readily accessible on drug store shelves.
“I could count 100 opioid-related problems for every nonsteroidal recognizable problem I see,” Lewis Nelson, an emergency medicine specialist in New York, told the Journal Sentinel. “I literally don’t see nonsteroidal problems, and I see tons of opioid-related problems.”
Getting adequate pain relief is a pressing concern for older adults with osteoarthritis, back problems, hip or knee replacements, and other medical issues. It’s important that they receive unbiased advice from physicians who in turn are educated by professional societies without any financial stake in the recommendations they make.
This is why the story is so important and why it merits close attention.
Also, older adults take more drugs, on average, than any other age group and therefore represent an enormous potential market for any pharmaceutical firm looking to increase sales. Since 2007, prescriptions for popular narcotics dispensed to people 60 and older have increased 32 percent, the Journal Sentinel found.
Judith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.
If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.
Finally, a bit of background. Anyone who’s followed Fauber’s work over the years knows that he’s passionate about pursuing potential conflicts of interest in medicine. Pain medicine is his latest target. Before this latest story, Fauber explored what he calls “a network of pain organizations, doctors and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the companies that made them.” Last year, he examined the University of Wisconsin Pain & Policy Studies Group and its role in encouraging the more liberal use of opiates by physicians.
ProPublica also delved into this topic with an investigation of the American Pain Foundation, which closed its doors in May after the U.S. Senate Finance Committee launched an investigation into opiate manufacturers and several national organizations that advise patients or educate physicians. The American Geriatrics Society is one of those organizations.
Meanwhile, a two-day FDA public meeting concluded that “Opioids can be a very effective pain treatment, but whether they work well at treating chronic noncancer-related pain long term is unclear and sorely needs more study.”
