67. Drugs, Pain and Death

FDA approval means that a drug has demonstrated safety and efficacy.  Recently The FDA pulled Darvon, aka propoxyphene, from the market.  Studies 30+ years ago demonstrated that Darvon provided no more pain relief than placebo, but safety issues have been more controversial.  Now with 10,000 deaths atributed to its use, the FDA decided to remove it.  No tears shed.

A leading pain expert wants the same judgement on Demerol, aka meperidine: "It's toxic and sedating." Toxic as in seizures, etc.

When I was working at small hospitals without anesthesia support (i.e., no epidurals), we offered Demerol, with many takers.  Efficacy is not questioned here as was the case with Darvon, and safety concerns are complicated.  Metabolites (compounds produced as the body breaks down Demerol) are long-lasting, something you don't want in a pain killer because of the temptation for both provider and patient to keep increasing the dose for episodes of acute pain, unaware that several hours later the additive effects of Demerol and its metabolites can be life-threatening.  My currently hospital/clinic don't allow its use.

Demerol may have been the final (though certainly not the only) cause of Michael Jackson's death.