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Marketing Pushes Powerful Painkiller Far Off-Label — Physician’s First Watch

Medical News |
May 15, 2014

Marketing Pushes Powerful Painkiller Far Off-Label

By Joe Elia

A painkiller approved by the FDA specifically for cancer patients on 24-hour pain relief has only about half of its prescriptions being written by oncologists and pain specialists, according to a New York Times report.

Subsys, a sublingual spray formulation of fentanyl, is marketed for "breakthrough cancer pain relief," yet according to the Times story, "a wide range of doctors ... including general practice physicians, neurologists and even dentists and podiatrists" account for almost half the prescriptions.

Interviews of former sales reps by the Times "suggest the company [Insys Therapeutics] ... has aggressively marketed the painkiller, including to physicians who did not treat many cancer patients," and paid higher sales commissions for selling higher doses.

Insys says it's cooperating with a federal investigation of its sales and marketing practices. It has also announced plans to seek additional indications for the drug.

Reader Comments (1)

Martha J Lynch PA-C Other Healthcare Professional, Internal Medicine, Ambulatory clinic

As a Physician Assistant who has worked with dying cancer patients and geriatric patients for nearly 20 years this situation has a seriously flawed premise. The notion that podiatrists or dentists would prescribe fentanyl, in any formulation, seems ludicrous, It has become a world in which zero pain is set as the target. With that utopian view it isn't a wonder that inappropriste use of this medication is running afoul.
My experience after my first six years in Oncology was that cancer patients rarely become addicted to pain medications. Most of them want to live so much that acceptance of some pain is an acceptable trade off to them.
Everyone, everyone has some pain. It is life. Defining your own acceptable level of pain often begins when a well educated physician helps set your expectations correctly.
That seems to be where we have lost our way. I don't promise any patient , EVER, they will be pain free.
And a responsible physician won't. Instead, with my patient, together we figure out what level of "pain" is livable. That means addressing all compinents of quantifiable physical pain as well as other components such as stretch and swelling types of discomfort and the help that movement and other non-medicinal measures can bring.
But one of the most powerful aspects of pakn is the immeasurable "subjective suffering". I don't believe there is an opioid that will ever fix that, In that place of suffeing the best medicine is helping a patient figure out the components of suffering in order to attenuate their effect on physical pain.
Our current health system culture doesn't permit or reward physicians or practitioners for the investment of time to accomplish this.
Physicians, we are charged with setting correct expectations. Life has physical pain and suffering.
A pill or an spray isn't the only answer for one who is asking the right questions of your patients.

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