We all know the toll the opioid epidemic has taken on the United States. In 2016, 42,249 people died of opioid overdoses – that’s more than 115 people every day. Some people start out with the hard stuff, but many people who end up addicted to heroin or other more serious drugs started out taking a legitimate prescription pain medication. As a result, doctors are being more careful about the number of opioid prescriptions they write and how long they’re good for. Unfortunately, this isn’t just affecting the people who misuse the medications, but people with severe, chronic pain who are now being denied relief and must turn to other, more dangerous methods.
One increasingly common way that people are battling back pain in particular is with an injectable drug called Depo-Medrol, which is made by Pfizer. It is approved is approved for injection into muscles and joints, but doctors have long given shots of Depo-Medrol, or its generic equivalent, close to the spinal cord to treat pain in backs and necks, and for conditions like spinal stenosis (a narrowing of the spinal canal that puts pressure on the spinal cord and nerves).
The label clearly states that not only is the injection meant to tide people over in times of acute pain, not to treat chronic problems, but that it is contraindicated for intrathecal administration, meaning it’s not recommended for use so near the spine. This warning only appeared after the Pfizer received hundreds of complaints about complications and injuries. The pharmaceutical company asked the Food and Drug Administration to ban that sort of treatment, citing the risk of blindness, stroke, paralysis, and death. The FDA declined and merely added the warning to the label. Other countries, including Australia, Brazil, Canada, France, Italy, New Zealand, and Switzerland, heeded the request. According to Pfizer, it cannot stop doctors from using the drug for these purposes without a ban issued by the FDA.
Use of the injections declined somewhat as the risks of off-label treatment became known, but now people are turning to it again as an alternative to opioid medications. Not only that, but insurance companies are pushing for it. In June 2018, the House of Representatives approved an increase in Medicare reimbursement for the spinal injection. According to the IQVIA Institute for Human Data Science, total sales of both brand name and generic Depo-Medrol grew 35 percent to $185 million from $133 million from 2015 to 2017. FDA records show that 2,442 serious problems reported from Depo-Medrol injections between 2004 through March 2018, including 154 deaths.
Some doctors say that Pfizer was simply worried about liability from the off-label use. Other critics say that interventional pain doctors are exploiting the opioid crisis to push the use of their preferred methods and medications.
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