Outbreak Casts Doubts On Steroid Injections
October 7, 2012

Meningitis Outbreak Casts Doubts On Safety Of Epidural Steroid Injections

redOrbit Staff & Wire Reports — Your Universe Online

Doctors are debating the use of epidural steroid injections to relieve back pain in the wake of a fungal meningitis outbreak that has killed five people and caused at least 40 others to fall ill after receiving the shots.

According to AP Medical Writer Lindsey Tanner, hundreds, possibly thousands, of patients across 23 states are being told to be on the lookout for symptoms associated with the infection, which may have been caused by a custom-mixed solution of steroids that was contaminated with fungus.

Tanner reports that doctors who perform these injections say they are typically "extremely safe when done correctly with sterile drugs" that have been approved by the Food and Drug Administration (FDA). On the other hand, the AP writer says that medical professionals tend to avoid using products originating from "generally less-regulated 'compounding pharmacies'" such as the firm whose products have been linked to the outbreak.

All of those affected "received spinal injections of a steroid solution prepared by New England Compounding Center, a compounding pharmacy in Framingham, Mass.," Duane Marsteller of The Tennessean reported on Saturday. "The pharmacy has voluntarily ceased operations and recalled the steroid, which health officials suspect was contaminated with one or more fungi. Almost 17,700 vials were shipped to about 75 facilities in 23 states as far away as California."

Several other, unrelated products were also recalled as a precautionary measure.

As the investigation into the matter continues, Marsteller said that some patient advocacy groups have called for greater restrictions -- perhaps even a complete ban -- on the injections. However, as he points out, "those who give the injections say they are safe when done properly and note the current outbreak appears to have originated from the medicine, not the procedure itself.

Washington-based Dr. Ray Baker told The Tennessean the risk of epidural injection-related complications was "very small“¦ we're talking about a very safe procedure that has been performed for a very long time." He said he believed that only one out of every 100,000 injections led to serious complications, though he admitted that there were no official statistics available to support his theory.

Likewise, Dr. Michael Schafer, an orthopedic specialist at Chicago's Northwestern Memorial Hospital told the AP in nearly 40 years of giving epidural injections he had never had a patient develop an infection. Dr. Michael Drass of Allegheny Pain Management in Pennsylvania said he had given more than 50,000 injections without ever seeing or hearing of someone contracting an ailment like meningitis from the procedure.

Not everyone sees it the same way, though. Tennessee-based psychological rehabilitation specialist told Marsteller that something like this happening was "inevitable" and that the procedure -- which requires doctors to use a three inch needle to inject the steroid into the epidural space around the spinal cord -- "is not safe." Furthermore, Dr. Schafer admitted to Tanner, "If I was a patient, I would definitely be concerned."