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. Continue reading
