I wrote my first post on opioids and workers’ comp. Almost two decades later, the post – which was really an excerpt from a Workers’ Comp Insider blog post – is terrifyingly prescient.
Interesting item from Workers Comp Insider today:
There is an interesting convergence of issues concerning the pain killer, Oxycontin. Originally developed to combat cancer pain, Oxycontin has been aggressively marketed over the past three years by its manufacturer Purdue, to the point where the drug is now the pain-killer of preference for work related injuries. This drug is twice as powerful as morphine and, while not technically addicting, it can create withdrawal symptoms when a person stops taking it. According to a study by NCCI, Oxycontin is prescribed for pain in 69% of permanent partial disability cases. This same study also points out that 49% of these prescriptions go to people with back injuries. When you combine that with the next interesting piece of data – Oxycontin is almost always dispensed in 50 day supplies (100 tablets) — you have a potentially volatile mix.
Kudos to Tom Lynch and Julie Ferguson for their early warning.
Dr Steve Feinberg sent me a note re the CDC’s just-released update to opioid guidelines; there’s a lot to unpack here. A couple of key takeaways.
- the guidelines were just that – guidelines. In far too many instances they were used to define hard limits, which was wildly inappropriate and completely inconsistent with CDC’s guidance.
- this from Christopher Jones, acting head of the CDC’s National Center for Injury Prevention and Control and a co-author of the updated guidelines:
- “The guideline recommendations are voluntary and meant to guide shared decision-making between a clinician and patient…It’s not meant to be implemented as absolute limits of policy or practice by clinicians, health systems, insurance companies, governmental entities.”
What does this mean for you?
Pay attention to early warning signs and don’t over-react.
I must admit my eyes were open to this problem around 12 years ago when I realized that we had created a generation of opiate addicted injured workers and that every time I did a C&R on one of these cases I was giving a loaded gun to the the applicant. Thankfully we have made great progress since then. Sadly, Joe you observations 19 years ago were prophetic.
Thanks much Saul – sometimes I hate it when I’m right.
best Joe
Joe: Thanks for all your efforts across the years. Your work has been an inspiration for many in our industry to tackle this problem
Marcos – I’m humbled by your kind words. Thanks for that, and for being a big art of an ongoing solution.
be well Joe
I worry quite a lot about the implications of comments like the one from Dr. Feinberg. On the one hand, I have a lot of respect for Dr Feinberg and the work he’s done over the years of helping patients. I am also a huge proponent of care being a process of shared decision-making cantered on good care, which means that guidelines aren’t “rules” to be mindlessly followed. But that said, I can already hear those providers, uninformed at best and unscrupulous at worst, who will be over-prescribing useless opioids for chronic pain in the name of “collaborative care” that ends up disabling and killing far too many, for far too little benefit. Yes, let’s not make guidelines into rigid rules for which there are no exceptions, but let’s make it hard to justify an exception to guidelines built on huge bodies of clear research. We must not reverse these past few years of early, hard-fought progress on deaths related to prescribed opioids (illicit fentanyl is of course a different matter and the current main driver). Keep up the great work, Joe
Thanks Les – really appreciate the kind words and your continued focus on doing the right thing.
be well Joe