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Opioid prescribing plan lacks guidance on workers comp issues

Opioid prescribing plan lacks guidance on workers comp issues

The U.S. Centers for Disease Control and Prevention's proposed opioid prescribing guideline for chronic pain is a step toward improving patient safety, but it falls short when addressing long-term users.

The voluntary guideline, released Monday along with a Federal Register notice of a 30-day comment period on the proposal, is aimed at primary care providers who prescribe opioids for “chronic pain outside of active cancer treatment, palliative care and end-of-life care.”

With health care providers writing millions of prescriptions for opioid pain relievers in 2012 (see chart), the CDC's proposal attempts to address the epidemic.

Workers compensation is not immune, as many industry professionals say opioid abuse is the biggest issue they face.


• 259 million opioid prescriptions in 2012 were enough for every U.S. adult to have a bottle of pills.

• Opioid prescriptions increased 300% since 1999, but the overall amount of pain reported has not changed.

• 2 million people 12 and older abused or were dependent on opioid pain relievers in 2013.

• More than 16,000 people died of opioid-related overdoses in 2013, four times the level of 1999.

Source: Centers for Disease Control and Prevention

“It's really important that CDC take the lead on opioid guidelines,” said Michael Gavin, Duluth, Georgia-based president of medical cost management company PRIUM. “It's the right agency to do it. They have the voice, they have the bully pulpit and they should have the credibility.”

Recommendations in the proposal cover when to initiate or continue opioids for chronic pain; how to select the drugs, dosage and duration; and how to assess the risks of use.

For example, the CDC guideline suggests establishing treatment goals, and discussing known risks and realistic benefits before prescribing opioids, as well as starting patients on immediate-release opioids instead of extended-release/long-acting opioids to prevent manipulation, such as the injection of opioids intended to be taken orally.

Mr. Gavin said he's “concerned that there's no guidance on weaning and tapering.”

“The guidelines don't appear to be particularly useful for patients already on chronic opioid therapy,” he said, adding that it's unclear whether the proposal would influence the workers comp industry's thinking about legacy chronic pain claims.

More in-depth prescribing guidelines devised by organizations such as the American College of Occupational and Environmental Medicine and Washington State already are used in workers comp. But the industry still can benefit from the CDC guideline, which will help “general practitioners gain a level of insight and education that they might have been missing before,” Mr. Gavin said.

Despite saying the proposed guideline is “based on the most recent scientific evidence, informed by expert opinion, with stakeholder and constituent input considered,” stakeholders criticized the CDC for initially planning to keep the draft under wraps.

Some speculated that the secrecy stemmed from not wanting drugmakers or pain management physicians to influence the guideline.

The Washington Legal Foundation last month made a request under the Freedom of Information Act asking the CDC to release all documents related to the guideline.

The Washington D.C.-based public interest law firm and policy center said on its website that advocates for patients suffering from chronic pain fear the CDC's guideline “would deprive patients of adequate treatment.”

Comments on the proposed voluntary guideline will be accepted through Jan. 13. 2016. More than 90 comments, many of which were posted by chronic pain patients, already had been submitted as of Thursday, according to the "Contact us" web page.

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