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 activities.
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:
1) Determining when to initiate or continue opioids for chronic pain;
2) Opioid selection, dosage, duration, follow-up, and discontinuation; and
3) Assessing 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 physicians.
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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