Medicine: Stir over Darvon

As director of Ralph Nader's Health Research Group, Dr. Sydney Wolfe has prodded federal agencies into protecting the public against a number of health hazards, from Red Dye No. 2 to chloroform. Though Wolfe's critics grudgingly acknowledge his effectiveness, they maintain that he is overzealous. Last week Wolfe gave critics some new ammunition.

In a letter to HEW Secretary Joseph Califano, Wolfe asked for an immediate ban on the sale of the widely prescribed pain reliever propoxyphene, best known as Darvon. He claimed not only that Darvon is an ineffective painkiller, but also that in excessive doses it produces a euphoric high, which he says, "makes it attractive as a drug of abuse. This is tantamount to legalized dope." Further, said Wolfe, Darvon-related deaths in the U.S. have been increasing, rising in major cities to about 600 last year and making the compound "the deadliest prescription drug in the United States." Eli Lilly and Co., of Indianapolis, the principal manufacturer, promptly branded Wolfe's charges "irresponsible and clearly not supported by the facts."

Darvon-related deaths have often involved intentional misuse, either by overdosing or mixing with alcohol and other drugs. Lilly notes that the average person would have to take 30 large-size Darvon capsules at one time (the usual dose is one every four hours) to cause death, 15 if he were intoxicated. Further, the drug is a controlled substance—a prescription is good for only five refills within six months. (If HEW will not ban Darvon, Wolfe wants the drug reclassified so that prescriptions cannot be refilled.)

Lilly also says that Wolfe's claim about Darvon's effectiveness is misleading because it is largely based on studies of single, rather than multiple, doses of the drug. Doctors prefer Darvon for some patients because, unlike aspirin, it does not cause gastrointestinal bleeding or lower the body temperature. Concludes Lilly's Dr. Robert Furman: "Used as directed, Darvon is really very safe. The fact that some people are intent on abusing it shouldn't be used to indict it."