An article about opioids and chronic pain featured in WorkCompCentral‘s [subscription required] professional columns section this week should be required reading for anyone involved in comp.
The explosive growth in the use of opioids among the general population, and specifically among workers comp claimants, is well-documented. When drug seeking hits the front page of USAToday, you know it’s well past the point of becoming a national disaster.
The piece, authored by Dr Steven Feinberg, provides an excellent overview of the issues inherent in managing pain with opioids – here are a few notable insights.
– there’s been a “dramatic increase in accidental deaths associated with the use of prescription opioids and also an increasing average daily morphine equivalent dose…”
– the lowest effective dose of opioids should be used along with patient agreements, random periodic and targeted urine testing
– at this time there is no clear evidence that long-term opiate therapy for chronic back pain is efficacious. (about half of work comp narcotic scripts are for claimants with back issues)
– ACOEM’s 2008 pain chapter guidelines suggest “opioids should not be used when there is no evidence they provide increased function.” Read this again – functionality is the key to prescribing, not pain.
There are a wealth of sources of information about appropriate usage of opioids freely available on the web. All the reputable ones are pretty much in agreement – for non-cancer patients, opioids may be helpful in facilitating a return to functionality, but long term usage is fraught with problems, many of them serious.
What does this mean for you?
If you don’t have a opioid strategy, now may be a good time to put one together, or ask your PBM for guidance.
Feb
24
Excellent article.
This is a sad result of a system that is strongly influenced by insurance companies to conclude an injured worker’s claim for benefits.
Opioids are the only pain relief offered to injured workers here in South Australia. The workers compensation system does not offer alternative pain therapy.
Speaking from my own personal experience of 3 yrs on opioids, I became addicted to taking it, and at the end of my own tolerance of not being “alive” I could not tell the difference of pain from my injury or the need my body had for the next “hit”.
It took me 6 weeks to detox myself -my doctor would not put me into a clinic- I went through every layer of hell from the withdrawal and learning how to control the pain of my injury at the same time.
I had no help, I was actually too ill to even know I really needed help.
I know just how easy it is to slip into addiction, so now I refuse to take anything even for a headache.
Opioids are brilliant short term pain control, but they should never be prescribed as long-term medication.
I’ve seen the insurance companies blamed for many things but I don’t know that I’ve ever seen them blamed for the opioid use/abuse in workers’ comp. Almost amusing….