FDA Panel Recommends Ban on Popular Painkiller

An advisory panel has recommended that the FDA place a ban on the painkiller Darvon, one of the most widely prescribed opioid painkillers in the US for at least half a century. The ban would include generic propoxyphene (the active narcotic), as well as the brand-name drugs Darvon and Darvocet. The reason? Studies seem to indicate that the drug is no better than aspirin at controlling pain yet carries with it an excessive potential for abuse, addiction, overdose, and suicide.

Narcotic painkillers like propoxyphene fall into three broad classes:

NATURAL opiates: These drugs are derived directly from the opium poppy, like codeine and morphine. Morphine has been something of the gold standard among painkillers for a century.

SEMI-SYNTHETIC opioids: These drugs are derivatives based on the natural opiates and include hydrocodone (Vicodin, Lortab) and oxycodone (Percocet, Percodan, Oxycontin), among many others.

FULLY SYNTHETIC opioids: These drugs are pharmacologically divorced from the natural opium poppy and here’s where you find propoxyphene (Darvon, Darvocet) as well as methadone (Methadose), among others.

Among the benefits of a fully synthetic opioid is the fact that some patients don’t tolerate codeine and codeine derivatives—they’re allergic, for instance—meaning narcotic pain control has to come from one of these, if it comes from anywhere.

Opioid addiction is a very real possibility from any one of these drugs in any of the classes listed. Consequently, for chronic pain patients, the addiction factor is a double scourge: a scourge in that it discourages some doctors from adequately treating pain lest they create dependency in their patients, and a scourge in that they may truly develop a dependency. Either way, the patient loses.

Pain management is a legitimate branch of medicine. Hundreds of thousands of people rely on propoxyphene products to manage their pain. Should the ban take place, other options remain available, but not all of them are going to be any more or less attractive to government policy makers or consumer watchdog groups for the same reasons they don't like propoxyphene.

At any rate, the FDA isn't required to follow the panel's advice but should they do so, patients or their caregivers should consult with their doctor about other viable options for the management of their chronic pain.