Oxycontin for Kids

The FDA has approved Oxycontin for children. 

Before I editorialize, a few important facts:

• Specifically, the approval is for children ages 11-16 that require daily, round-the-clock, long-term pain relief for which no other alternative exists. 
• FDA actually requested that Purdue study this; this isn’t Purdue trying to extend its patent through dubious means.
• The only other FDA-approved long acting analgesic available to kids who have, say, incurable cancer, is Duragesic (or fentanyl).
• I have an 11 year old.  

That last fact turns out to be pretty important.  My first reaction to this news was outrage.  I’ve never pulled punches with my criticism of the FDA and I was fired up to skewer them again for being utterly tone deaf to the greatest public health crisis of our time.  But I first saw this news while sitting at the breakfast table with my three kids, the oldest of whom is 11.  After finishing a few articles on the FDA move, reading emails from several of you who struck tones of anger and confusion in varying degrees, and processing my initial shock, I looked up at my kids and wondered…

I am incredibly blessed to have healthy kids.  But if my kid had incurable cancer and he was suffering from intractable pain, would I want him to have Oxycontin available to him?  Yep.  I sure would. 

On the other hand, I thought… What if he blew out an ACL playing soccer when he’s 15?  Would I want him to have Oxycontin for post-op recovery, even if he was in great pain?  No.  Absolutely not. 

If we trust that Oxycontin will be used only in those extenuating and heart breaking circumstances for which this approval is intended, then I could support that. 

But what if the message coming through armies of pharma reps employed by Purdue is that Oxycontin is now approved for “round the clock pain management, when no other alternative exists… even for teens suffering from post-op pain related to major sports-related surgeries…”?  Do we have proper controls in place to ensure that doesn’t happen?   One need only read this crushing article in Sports Illustrated to understand that we’re already overprescribing opioids to teens, particularly athletes.  How do we make sure this doesn’t make it worse? 

Pediatric oncologists are thrilled. 

Public health advocates are gravely concerned.    

I'm not comfortable with ambivalence, but in the case I have to admit: Both are right.  

Michael
On Twitter @PRIUM1