A Capehart Scatchard Blog

CDC Releases Guideline for Prescribing Opioids for Chronic Pain

By on April 22, 2016 in Controlling Costs with 0 Comments

Pain management has become a major health issue and cost driver in most state workers’ compensation programs with the proliferation of prescription opiates and consequential addictions arising from workers’ compensation injuries.  One of the central problems that practitioners face in file handling and in court is the absence of any clear standards to decide whether opiates are reasonable and necessary.  The Centers for Disease Control and Prevention (CDC) took a significant step forward on March 18, 2016 with the release of the “CDC Guideline for Prescribing Opioids for Chronic Pain.”

The study is available online and any practitioner of workers’ compensation will find its conclusions to have practical applications to the daily problems employers, third party administrators and carriers have with cases involving prolonged use of opiates.  The focus year for the study was 2012.  In that year alone, family doctors and internists wrote 259 million prescriptions for opioid pain medications.  This number does not include the number of prescriptions that pain medicine specialists and other physicians wrote.  The CDC said it was focusing on family physicians because they tend to write about half of all opioid prescriptions.

The Guideline addresses long-term opioid therapy, which is defined as use of opioids on most days for more than three months. Here are some of the key findings in the Guideline:

  • Concurrent use of opioids and benzodiazepines might put patients at greater risk for potentially fatal overdose
  • Patients who do not experience clinically meaningful pain relief early in treatment (within one month) are unlikely to experience pain relief with longer-term use
  • No evidence shows a long-term benefit of opioids in pain and function versus no opioids for chronic pain with outcomes examined at least one year later

 These observations are particularly relevant to workers’ compensation practitioners, who know intuitively that it does not make sense to continue to prescribe opiates for patients for many months or years when they do not seem to be improving in function or experiencing a diminution in pain.  Even after prolonged use of opiates, many workers’ compensation patients will complain of a pain level of 10 on a scale of 10.  Such prolonged use of opiates often leaves injured workers with even greater problems from dependency and addiction.

 The authors of the Guideline have provided some valuable advice for physicians:

  •  Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient
  •  Consider non-pharmacologic therapies (PT, weight loss for knee osteoarthritis, Cognitive Behavioral Therapy) to alleviate chronic pain
  •  NSAIDs, acetaminophen, and some antidepressants may be effective for chronic pain

 One theme that permeates the Guideline is that physicians should set a benchmark when they prescribe opiates, and that benchmark should be to achieve both improvement in pain as well as improvement in function.  The Guideline also advises that physicians should not start patients on extended-release opioids.  This would seem like common sense but many physicians leap to prescribe extended release opioids like oxycodone, hydrocodone, and morphine before trying shorter acting opioids.  The lowest possible dosage should be the starting dosage – again, a rule that is often violated in workers’ compensation cases.

 Workers’ compensation practitioners can now draw on the CDC Guideline in asking physicians for a treatment plan and specific timelines.   The CDC suggests evaluating benefits and harms with patients within one to four weeks after starting opioid therapy for chronic pain.  The authors suggest that physicians should periodically review the patient’s history of controlled substance prescriptions using the PDMP (Prescription Drug Monitoring Program).  New Jersey is one of the states that utilizes the PDMP.  Our office has found any number of cases where a claimant’s name has been run through the PDMP only to discover that the claimant is already getting multiple prescriptions for the same opiate that the pain medicine physician was about to prescribe.

One comment from the lengthy Guideline that should resonate with workers’ compensation practitioners, employers, third party administrators and carriers is this one:

“Regarding duration of use, patients can experience tolerance and loss of effectiveness of opioids over time.  Patients who do not experience clinically meaningful pain relief early in treatment (i.e., within one month) are unlikely to experience pain relief with longer-term use.”   Most pain medicine physicians appreciate the points made in this Guideline but there are many who seem to be ignoring the sensible conclusions contained in this report.

Share

Tags: , ,

John H. Geaney

About the Author

About the Author:

John H. Geaney, a shareholder and co-chair of Capehart Scatchard's Workers' Compensation department, began an email newsletter entitled Currents in Workers’ Compensation, ADA and FMLA in 2001 in order to keep clients and readers informed on leading developments in these three areas of law. Since that time he has written over 500 newsletter updates.

Mr. Geaney is the author of Geaney’s New Jersey Workers’ Compensation Manual for Practitioners, Adjusters & Employers. The manual is distributed by the New Jersey Institute for Continuing Legal Education (NJICLE). He also authored an ADA and FMLA manual as distributed by NJICLE. If you are interested in purchasing the manual, please contact NJICLE at 732-214-8500 or visit their website at www.njicle.com.

Mr. Geaney represents employers in the defense of workers’ compensation, ADA and FMLA matters. He is a Fellow of the College of Workers’ Compensation Lawyers of the American Bar Association and is certified by the Supreme Court of New Jersey as a workers’ compensation law attorney. He is one of two firm representatives to the National Workers’ Compensation Defense Network. He has served on the Executive Committee of Capehart Scatchard for over ten (10) years.

A graduate of Holy Cross College summa cum laude, Mr. Geaney obtained his law degree from Boston College Law School. He has been named a “Super Lawyer” by his peers and Law and Politics. He serves as Vice President of the Friends of MEND, the fundraising arm of a local charitable organization devoted to promoting affordable housing.

Capehart Scatchard is a full service law firm with offices in Mt. Laurel and Trenton, New Jersey. The firm represents employers and businesses in a wide variety of areas, including workers’ compensation, civil litigation, labor, environmental, business, estates and governmental affairs.

.

Post a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Top