Start with the science

The U.S. Food and Drug Administration is taking an overdue look at the use of prescription opioids to treat chronic, long-term pain amid increasing calls that it should be illegal to market these drugs for such use.

A Journal Sentinel/MedPage Today investigation found that since 2007, top-selling opioids dispensed to people 60 years and older have increased 32 percent, based on an analysis of prescription data from IMS Health, a health care information company. The safety and effectiveness of such drugs for chronic pain is unproven, the investigation found; some experts believe the drugs are harmful for older patients.

The increasing use of opioids is partly the result of recommendations by doctors and pain advocacy groups that receive money from drug companies. These advocates have downplayed the risk of the side effects, including overdoses, an increased risk of falls and fractures in older people, cognitive problems and a condition in which opioids actually cause more pain.

"We need to start with science," Douglas Throckmorton, FDA’s deputy director of the Center for Drug Evaluation and Research, said during a two-day meeting on the issue last week. "We know less than we would like to about chronic, non-cancer pain."

More study of the use of prescription opioids is needed, as the FDA’s Throckmorton points out. But the evidence so far suggests a worrisome trend of care for the elderly that the agency needs to address.