The compounding pharmacy industry has taken a big hit in light of the recent and ongoing meningitis scare. Compounding is a practice of grinding medications into liquid or topical forms. Unfortunately, the contaminated medication that caused this terrible mess was produced by a compounding pharmacy. This incident has brought to light the fact that this industry is not subject to the same oversight and regulations as traditional pharmaceutical manufacturers. This fact is true, and the calls for greater oversight and regulation are reasonable.
However, this tragic incident should not discount the great potential value of these pharmacies. The medication involved in the meningitis scare was one injected into the spine. Most medications created by compounding pharmacies are not used in such high risk circumstances. Most are simple creams that can be put on the skin that are extremely safe. As a physician that treats cancer pain, I have found these compounds to be an incredibly valuable part of my practice. Most oral medications for pain have side effects. Some of these side effects can be quite severe and debilitating, which can prevent the patient's pain from being managed effectively. Pain medications can also interact with the patient's other medications. This is a big problem because it's very common (especially in my patients) for people to be on multiple medications.
A topical pain compound can effectively treat pain, with a very low likelihood of side effects or interacting with other medications. Another great benefit to these compounds is that multiple different pain medications can be combined to maximize pain relief. This is important because often there can be different components to a patient's pain (nerve pain, inflammation, muscle spasm). A compound can address all of these factors. In my practice, I have been able to get many patients completely off of their oral medications by safely prescribing a compound. I have rarely seen side effects from compounds except for very minor skin irritation, and even that is quite unusual to see.
I have no financial ties to any pharmaceutical industry, compounding or otherwise. I am writing this because I think it is important that the strong reaction to this terrible incident, does not bury a very effective medical treatment. I have found compounds critical to my patient care, and I have many patients who can testify to this. One reasonable argument against compounding is the lack of evidence based research of compounds. This, unfortunately, is also true. I am personally working on producing some topical compound research to help support this practice. It is important to note that there are much riskier interventions in medicine that are also lacking in evidence. Compounding creams are very safe and probably cost effective.
Most doctors do not learn how to prescribe compounds. If your doctor doesn't know how, ask to be referred to one who does. As I said, it is true that this industry could probably use more regulation. I hope that any regulation that arises from this incident can help standardize the industry to allow it to become more mainstream and more accessible. This will allow patients to have more access to this safe, powerful and effective treatment.
