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New opioid guidelines recommend cutting maximum daily dosing in half


While the release of Zohydro ER into the market has sparked concerns among workers compensation experts, a new set of prescription guidelines advises cutting opioid dosing limits in half to save lives and reduce addiction.

Reed Group Ltd., a disability case management services firm in Westminster, Colo., released its opioid treatment guidance last month as part of its DisabilityGuidelines. The recommendations were developed for Reed Group by the American College of Occupational and Environmental Medicine.

Reed Group and ACOEM recommend limiting the average daily opioid prescription to a 50-milligram morphine equivalent dose, the measurement standard for opioid potency. Previous guidelines have recommended a morphine equivalent dose limit of 100 to 120 milligrams per day.

The new recommendation is based on "systemic reviews" of pain treatment studies and other analyses that provided a significant amount of data on opioid prescriptions, said Dr. Kurt Hegmann, director for the Center for the Rocky Mountain Center for Occupational and Environmental Health in Salt Lake City.

Statistics showed "a meaningful increase in fatalities was present" in cases that had more than 50 milligrams of morphine equivalent dosing per day, Dr. Hegmann said.

He noted that the previous guidelines are several years old, and are based on expert opinion rather than statistics.

The new recommendations from ACOEM and Reed Group also include several best practice recommendations. They include providing opioid prescriptions only if other, less risky pain treatments have failed for a patient, and only continuing opioid treatment when such medications provide an "objective, not subjective" increase in a patient's functionality, Dr. Hegmann said.