Public health officials still are assessing the damage from contaminated back pain injections that resulted in a national outbreak of fungal meningitis, which has been blamed for least two deaths in Florida.
So far, there are no reported cases in the Tampa Bay region. But the outbreak has raised concerns about exposure to contaminated medication and the safety of epidural injections, which are used for back and neck pain as well as to relieve pain in childbirth. The Times spoke with experts to get answers:
Were any doctors' offices in the Tampa Bay area administering the contaminated drug?
No, but several local offices did purchase other drugs from the manufacturer in question, New England Compounding Center, which has voluntarily recalled all of its drugs.
For example, Dr. Martin Orlick's ophthalmic practice in St. Petersburg occasionally used a steroid made by the compounder for eye injections. It has not been found to have been contaminated, but Orlick personally called all of his patients who had received this drug since August, said administrator Brian Loesch.
St. Luke's Cataract and Laser Institute also pulled from its shelves the one drug that it purchased from the compounder, which was not the tainted medication. "We are very closely monitoring the situation," said Kathy LeSage, director of surgical services at St. Luke's Surgical Center. "If there is any indication that drug we have used could be implicated, we will get the word out to our patients."
These are the other local practices that state health officials say purchased New England Compounding Center drugs: Brandon Ambulatory Surgery Center, Clearwater Pain Management Association, Eye Institute of West Florida, Dr. Gary Heller, Retina Associates of Florida, Dr. Susanti Chowdhury and Wall Healthcare.
Clearly, steroid injections for back pain can be risky. How effective are they for pain?
There's no convincing evidence that they do or don't work, according to a review of 18 studies on the use of injection therapy for back pain by the Cochrane Collaboration, a respected international group of medical experts.
Cochrane reviewers found "there is no strong evidence for or against" injection therapy for back pain. They noted that it's possible some patients could benefit.
Dr. Rafael Miguel, an interventional pain medicine specialist practicing in Brandon and Sarasota, said the Cochrane findings focused on long-term relief. The therapy provides meaningful, short-term benefits, he said.
"The whole goal (of steroid injection therapy) is to minimize inflammation around the swollen nerve root and the disk," he said. "By doing that, it makes the patient much more comfortable. How long that persists depends on the degree of disease the patient may have."
Miguel said the patients seeing the best results are able to participate in physical therapy after receiving the injections. And through physical therapy, some obtain relief from the underlying cause of their back pain.
But Dr. Juan Uribe, an assistant professor of neurosurgery at the University of South Florida who practices at Tampa General Hospital, acknowledged that the Cochrane reviewers had a point. "It's not like a black-or-white answer," he said. "It's a good option, but it has its own particular indications, and if early on this option of treatment doesn't work, it should be abandoned."
He doesn't perform the treatments personally, he added, because he believes distance helps him to evaluate whether or they are working without bias or financial incentive.
Is it safe for women in labor to get epidural injections?
A completely different medication is used in the epidurals women are given during childbirth.
"Epidurals are safe. Underline that," said Dr. Madelyn Butler, an ob-gyn who founded the Woman's Group, a private practice with several offices around Hillsborough County. "It's been used for years and years and years and — under the supervision of a qualified anesthesiologist — it's very, very safe."
"I don't want a bunch of women being scared that if they get one they are going to get a horrible fungal infection," she added.
Why were medical offices purchasing medications from a compounder in New England?
Cost and availability may have been factors. The New England Compounding Center was able to supply medications sometimes hard to obtain elsewhere at a time of national drug shortages, said Tim Bedgood, director of materials management for the Brandon Ambulatory Surgery Center, noting that his office rarely used the center. And it no longer has any of its products.
But the outbreak raises a valid concern for patients, who should never feel shy about asking doctors where they obtained their injectables, noted Dr. Miguel, the interventional pain medicine specialist. His practice, which provides injection therapy on an almost daily basis, uses only brand-name drugs from large companies subject to the Food and Drug Administration's stricter quality controls, he said. But brand names are more expensive than the compounders, he said.
Letitia Stein can be reached at firstname.lastname@example.org or (727) 893-8330.