WSJ on pain meds

by rcentor on December 26, 2004

The Painkiller Panic (registration required)

Of course, drugs also have huge benefits. And this page has long argued that in almost all cases the right people to weigh them against the risks are doctors and patients, not courts and regulators.

One of the most frustrating things about the latest news on painkillers is that almost none of the people reporting it understand the concept of relative risk–i.e., that a doubling of adverse events like heart attacks still doesn’t mean that event is very likely. A doubled risk might well be a chance worth taking, especially if the baseline risk is low to begin with and the drug’s benefits are significant for the patient in question. All of us implicitly accept this proposition with chemotherapy, for example, which poisons the entire body to kill a few cancer cells.

Why shouldn’t we look at painkillers the same way? If you suffered from disabling arthritis and understood that your baseline risk for heart attack or stroke over a given time period was less than 1%, you might be willing to accept a doubling to a mere 1.5%. That’s in fact what the study leading to the withdrawal of Vioxx in September found: 7.5 events per 1,000 in the placebo groups versus 15 per 1,000 among those taking the drug (and only after 18 months at a high dose).

Think patients don’t actually approach their treatment this way? Consider Dave Ellis, who was featured in a Journal news story on Tuesday. The 66-year-old Mr. Ellis, who has suffered for 30 years from degenerative arthritis in his spine, says he dreads the day two months from now when his supply of Vioxx runs out. “If I look at the numbers, I just don’t feel I’m at risk,” said Mr. Ellis, who has no family history of heart disease. Is Mr. Ellis an ignorant rube duped by drug industry advertising? No, he’s a retired pharmacist.

This article contains the most logical reasonable take on this subject that I have read. As we all know, drugs have side effects. We must allow physicians and informed patients to make decisions based on the probability of those side effects and their (the patient’s) willingness to accept the risks.

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{ 2 comments… read them below or add one }

arf December 29, 2004 at 3:14 pm

In today’s WSJ editorial 12/29/2004:

“At least you can still get Percodan”

No side-effects there………[/irony]

Dan February 5, 2009 at 11:56 am

The Dangerously Euphoric Violet Delight

Often, medications for pain are made from opoid plants. These purple-flowered plants produce opium poppies, which are used in the production of the analgesic, opium. Opium is what we in the U.S. call narcotics, and they dull and numb one who ingests what may be made by these opium poppies, as there are several drugs that have been developed from what these plants provide that are these prevalent narcotics.
Some medications are from natural opium, such as cocaine, or the opiates from the poppy seeds can be used to create semi-synthetic medications, such as Heroin. Heroin was marketed by Bayer Pharmaceuticals for 12 years, and during that time this company told others that heroin was a non-addicting form of morphine (pure opiate drug), since there were many soldiers addicted to morphine after the U.S Civil War. During that same period of time, Bayer marketed heroin for children who coughed. Of course, Heroin is very addictive, and is pointless creation is no longer available.
While Poppy plants exist and are grown in areas of IndoChina, Afghanistan is the number one producer of poppy plants. The United States is the number one country that consumes what is derived from these plants. Opium-derived medicines once could be bought freely in the U.S. by anyone less than 100 years ago. Yet now, they are classified by the Drug Enforcement Agency as narcotics, and are scheduled by them, according to the danger they potentially could cause another who takes them.
While prescribed to patients for such issues aside from pain on occasion, such as chronic coughing and diarrhea, their greatest benefit is for the relief of pain experienced often by patients is the primary reason doctors prescribe opoid drugs, and they do so often. Vicodin, a mild narcotic, is the most frequently prescribed medication in the U.S. presently.
If patients take opium-derived drugs for long periods of time, tolerance may develop, and the patient may need to take more of the drug to acquire an effect of relief. In addition, the patient may develop a dependence on these types of drugs, which can lead to addiction and possible abuse. This is why overdose of these types of medicine occur- as the reasons for taking these drugs initially become replaced with relief due to addiction in some who take narcotics for a long period of time.

Dan Abshear

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