Narcotic pain pills from nine companies lack FDA approval for treating joint and muscle pain, and the agency has sent warning letters to cease and desist manufacturing and distribution.

The nine companies involved are Boehringer Ingelheim Roxane, Inc., Columbus, Ohio; Cody Laboratories, Inc., Cody, Wyoming; Glenmark Pharmaceuticals Inc., Mahwah, N.J.; Lannett Company, Inc., Philadelphia; Lehigh Valley Technologies, Inc., Allentown, Pa.; Mallinckrodt Inc. Pharmaceuticals Group, St. Louis; Physicians Total Care Inc., Tulsa, Okla.; Roxane Laboratories Inc., Columbus, Ohio; and Xanodyne Pharmaceuticals Inc., Newport, Ky.

The medications, 14 in all, are all powerful opiates that may include morphine sulfate, hydromorphone or oxycodone.

“It is a high priority for the FDA to remove [unapproved] products from the market,” said FDA director of the Center for Drug Evaluation and Research Janet Woodcock, “because they may be unsafe, ineffective, inappropriately labeled, or of poor quality.”

Alternative remedies that some studies have shown to have promise in pain management include a tart cherry-based herbal supplement for osteoarthritis, antioxidants for pancreatitis as well as meditation in older persons.