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Drugs to counteract opioid side effects further complicate treatment

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Supplemental treatments, called adjunct therapies, often are prescribed to help injured workers treat symptoms brought on by taking prescription opioids.

Common side effects include constipation, weight gain, dry mouth, nausea, lower testosterone, impotence and depression, said Dr. Teresa Bartlett, Troy, Michigan-based senior vice president and medical director of Sedgwick Claims Management Services Inc.

Sometimes patients will see that list and say, “No thanks, I'd rather tough this out for a little while than experience some of these side effects,” she said.

But for injured workers already taking opioids, workers compensation insurance sometimes pays for adjunct therapies.

“There's an old adage that physicians who start patients on opioids should also start them on some sort of laxative protocol,” said Tron Emptage, chief clinical officer at pharmacy benefit manager Helios in Columbus, Ohio.

Injured workers might be told to exercise, eat certain foods that help with constipation and try over-the-counter products first, Mr. Emptage said.

Workers comp sometimes also pays for prescriptions for Viagra and Cialis, which treat erectile dysfunction often caused by opioids, Dr. Bartlett said.

“Why not lower the dose and get (an injured worker) off the opioid rather than add three or four more drugs to treat the symptoms that the opioid caused?” Dr. Bartlett said. “It's maddening and it's sad.”

For one opioid, Actiq, adjunct therapies can mean dental work, Dr. Bartlett said.

Actiq, which contains the Schedule II controlled substance fentanyl, is approved by the U.S. Food and Drug Administration to manage breakthrough pain in cancer patients, but is often prescribed to injured workers.

Taking the form of a lollipop, Actiq can cause dental issues, Dr. Bartlett said.

The lollipop was “really designed for end-of-life care for people who are maybe a week to a month away from dying,” she added. In workers comp “we have people in their 40s and 50s taking them all the time, and now they're losing their teeth.”