As a New Jersey Petitioner’s worker’s compensation attorney,
many of my clients have suffered significant injuries, and suffer ongoing and
often severe pain. Many of these injured
workers have attempted to treat these injuries with conservative forms of
treatment, including physical therapy or injections. Others have opted for more aggressive
treatment, including surgical intervention. Often times these treatments provide only minimal pain relief or do not
relieve the pain at all. Many of these
injured workers have turned to opioid pain medication as a way of relieving
their chronic pain in order that they can function in performing their daily
During the past approximate 20 years, doctors in the U.S.
have been prescribing opioids to treat conditions such as back pain and
arthritis. Opioids include such
medications as Morphine, Methadone, Oxycodone and Hydrocodone. Beginning in the 1990’s, drug companies have
heavily marketed opioid medications to physicians. The message being that these opioids could be
safely prescribed and bring life changing relief.
With the increased use of opioids, the government, as well
as the medical and legal communities have come to recognize the
problems posed by the reliance on opioid medications. Reliance on opioids has raised concerns in
the worker’s compensation community in New Jersey and other states. Many opioid users, including injured workers,
have become addicted to these medications and have suffered other side effects
caused by these medications. Studies
show that the rate of opioid related deaths from overdoses on medications such
as Oxycodone and Hydrocodone continues to increase.
For years, the medical profession and policy makers ignored
growing evidence that prescription medications were causing a great deal of
harm. However, now that abuse of opioid
medications has reached epidemic proportions, the government is determined to
mount a much stronger response to it. It
is the belief of policy makers that with the vast majority of patients, the
known serious risks outweigh the unproven and transient benefits of opioid use
for chronic pain.
In March of 2016, in reaction to the growing concerns of the
risks of opioid use, the Centers for Disease Control (CDC) released guidelines
for the use of opioids. These guidelines
were released after several months of deliberation and input from various
interested parties. In releasing these
guidelines, the CDC relied on data from clinical trials which showed that the longer opioid medications are used,
the less effective they are against pain
or in helping patients recover, and that long term use of opioids significantly
increases the risk of addiction. They
relied on studies which suggested that there is no evidence that long term use
of opioids is beneficial, and in fact, exercise, physical therapy, and over the
counter medications can be more effective. The CDC explained that the guidelines are “intended to ensure that
clinicians and patients consider safer more effective treatment, improve
patient outcomes such as reduced pain and improved function, and reduce the
number of persons who develop opioid use disorder, overdose, or experience
other adverse events related to these drugs.
In their guidelines, the CDC has grouped the recommendation
into three areas for consideration:
when to initiate or continue opioids for chronic pain;
selection, dosage, duration, follow-up, and discontinuation; and
risk and addressing harms of opioid use.
These guidelines provide suggestions for how doctors should
prescribe opioid pain medications. The
CDC, is in fact, advising doctors not to prescribe opioids for chronic pain in
most situations. The CDC recommends that
primary care physicians try pain relievers like Ibuprofen first, and that they
prescribe only a few days worth of opioids when necessary. The guidelines advise doctors prescribing
opioids to start with low doses, prescribed for 3 days or less and rarely more
than 7 days. Doctors should warn
patients that the drugs are highly addictive and check prescription-monitoring
programs to determine if their patients are getting drugs from multiple
These guidelines are currently voluntary, but carry a lot of
weight with medical providers. The CDC’s
analysis will also likely influence how State governments develop laws and
regulations for opioid prescriptions.
For example, in Massachusetts, the governor recently signed a law that
forbids doctors from writing opioid prescriptions for more than a 7 day
supply. It has yet to be determined how
other States will act. . It seems likely
that these guidelines will influence worker’s compensation laws and practices
in New Jersey and other states.
While many welcome these guidelines, as a way of battling
the addiction problem, there are physicians and patients, including injured
workers that are concerned about the results of these guidelines. Despite the position of the CDC, many
physicians feel that many of their patients benefit from opioid use,
specifically for chronic pain. These
physicians are concerned that the guidelines will endanger effective treatments
for the patients that actually benefit from opioid use. In response to these physicians concerns, the
CDC explains that the guidelines are meant as a way for doctors to curtail use
of opioids, while basing decisions on the individual patient’s conditions.
Another concern expressed by physicians is that the
guidelines address the initial prescribing of opioids, but do not provide
guidelines for the weaning and tapering of patients currently on opioid therapy
for chronic pain.
Injured workers suffering from chronic pain are fearful that
being taken off opioid medications will take away any quality of life that they
have following their injuries. These
patients have expressed their concern that after having tried other forms of
treatment without success, they are working with their physicians around a sensible
prescribing routine that is working for them. They express fears that the CDC guidelines will interfere with the only
form of treatment that is working for them.
Another concern of injured workers, workers’ compensation
attorneys and physicians, is that removing chronic pain medications from a
program of opioid routines that have been working, will lead to increased
depression amongst these patients. To
remove the only form of treatment that has allowed these chronic pain patients
to function, will most likely lead to loss of function and ability to perform
activities of daily living among many of these patients. The inability to participate and function in
their own lives due to severe disabling pain will most likely lead to increased
psychological issues amongst these patients.
The argument for use of opioid medications is that these
prescription opioids, when taken with care, and as directed, allow many chronic
pain patients to live more normal, productive lives. These opioid medications, while they don’t
relieve all the pain, they do make the pain more bearable.
It is agreed that opioid use or overuse is a significant and
growing problem in this country and something needed to be done to deal with
this growing problem. The CDC’s
guidelines are a start to reducing opioid use and dependency. These guidelines should help to reduce the
use of opioids in the general population. These guidelines, however, do not fit for every patient. There are injured workers and other patients
who have benefited greatly from responsible opioid use for chronic pain. These opioids have significantly reduced
pain, allowed patients to better function in the activities of their daily
lives. While the guidelines will help to
reduce the number of patients who are prescribed opioids on a long term basis,
and will lead to less issues of opioid dependence and overdoses, we must not
forget that there are a number of patients who are using opioids responsibly
and benefiting greatly from the pain relief provided. It is important that these guidelines be
used strictly as a guideline.
Responsible physicians should continue to make decisions based on the
needs of the individual patient’s conditions and needs.
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