BI’s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.

To search specifically for more than one word, put the search term in quotation marks. For example, “workers compensation”. This will limit your search to that combination of words.

To search for a combination of terms, use quotations and the & symbol. For example, “hurricane” & “loss”.

Login Register Subscribe

Effectiveness of long-term opioid use in question

Effectiveness of long-term opioid use in question

A growing awareness of risks associated with long-term opioid use combined with questions about the drugs' effectiveness has caused them to be prescribed less in some states, according to a new study by the Workers Compensation Research Institute.

There is “little quality evidence” about the benefits of long-term opioid use for chronic noncancer pain, said study author Dongchun Wang. “Moreover, research finds that high doses and prolonged use of opioids may lead to addiction, increased disability, work loss, and even death.”

The study, released Tuesday, defined longer-term users as those workers who had opioids prescribed in the first three months after their injury and had three or more visits to fill opioid prescriptions between seven and 12 months after the injury.

It reviewed opioid prescriptions in 25 states for a two-year period and found that during that time claims from those who received opioids on a longer-term basis decreased by more than 2% in Michigan and decreased by 1% to 2% in Maryland, New Jersey, New York, North Carolina and Texas.

Workers compensation expert Joe Paduda, New York-based principal of Madison, Connecticut-based Health Strategy Associates L.L.C., agrees that there is little credible evidence supporting the long term use of opioids to treat chronic pain, and also that there is “much evidence that, for most patients, opioids are not the answer.” He also said that unless the prescriber is careful and thoughtful, patients are subjected to ever-escalating doses as the prescriber “chases the pain — a fruitless and highly dangerous practice.”

The report by Cambridge, Massachusetts-based WCRI confirmed that there is no evidence that longer-term opioid use among injured workers improves function or gets them back to work more quickly. In addition, some workers that used opioids longer-term may have had episodic pain from something besides their injury rather than chronic pain. These workers would not have been exposed to the risk of side effects, addiction and even overdose death if they had been more accurately diagnosed.

Although not specific to workers compensation or injured workers, the Centers for Disease Control and Prevention said in a Wednesday webinar that opioids should not be considered “first line or routine therapy” for chronic pain outside of active cancer, palliative, or end of life care.

Patients with a history of drug or alcohol abuse or other psychiatric conditions are less likely to benefit from long-term opioid treatment and will require close management by professionals who are addiction and pain control experts. “Chronic opioid management should only be offered after other therapies have failed,” the report said.

Guidelines mentioned in the study, “Longer-Term Use of Opioids, 3rd Edition,” recommended doctors look for signs of abnormal drug behavior and signs of psychiatric problems before prescribing opioid therapy.

However, the study reported that in most states, few injured workers who used opioids longer-term received psychological evaluations and psychological treatment. Even in Texas, the state with the highest use of these services, about 1 in 3 had a psychological evaluation and 1 in 8 received psychological treatment.

Read Next