On March 18, the CDC finally issued much-anticipated guidelines for the prescription of opioids in chronic pain management “outside of active cancer treatment, palliative care, and end-of-life care.” Over-prescription of opioids in the realm of workers’ compensation has long been an issue of national importance. 47,055 lethal drug overdoses occurred in the United States in 2014, the most recent year for which statistics are available, with 18,893 of those specifically prescription drug overdoses. Not all of those are tied to medication prescribed for work-related chronic pain management, but certainly, anyone who has been involved in workers’ compensation can attest to the “pill mills” in their local communities. The Northeast, with an aging, deconditioned work population and robust health insurance costs has been particularly at risk for non-occupational chronic pain complaints morphing into work-related injury claims with the resulting never-ending prescription of opioids for “pain management”. Pain cannot be objectively measured or objectively proven; it is inherently subjective and subject to individual experience and motivation. The CDC guidelines will, hopefully, provide measured guidance to physicians to assist in the proper use of prescription opioids in time-limited treatment protocols designed to address chronic pain.
The Opioid Guidelines group recommendations into three “areas for consideration”:
- Determining when to initiate or continue opioids for chronic pain;
- Opioid selection, doseage, duration, follow-up, and discontinuation; and
- Assessing risk and addressing harm of opioid use
The stated goal of the Guidelines is to improve communication between physicians and patients about the risks and benefits of opioid therapy in management of chronic pain. While there is evidence supporting short-term use of opioids to reduce pain and increase function, there really is no definitive study suggesting that any benefit is derived from long-term use of opioids for management of chronic pain. The Guidelines set forth twelve recommendations for “best practices” in the prescribing of opioids to manage chronic pain, including an emphasis on nonpharmacologic therapy as the first line of treatment. Ideally, the Guidelines will enable responsible parties to limit the time period for opioid therapy in chronic pain management, resulting in fewer long-term claims and a healthier workforce.