A Healthesystems publication

Spring 2014

Preventing Chronic Opioid Abuse

Chronic opioid therapy is preventable in many, but not all cases. To minimize opioid use, payers can work with their PBMs to develop pain management strategies that advocate for use of conservative therapies based on evidence-based guidelines. 

If a prescriber does not write an opioid prescription, the patient cannot develop an opioid dependence. It is a simple concept, but opioids are too often prescribed in workers’ compensation when non-opioid conservative therapies are indicated by evidence-based guidelines. Inappropriate prescribing can lead to chronic opioid therapy defined as opioid use beyond 90 days post injury.1 Opioids have not been proven safe or effective for treating chronic pain.2 Long-term opioid therapy is associated with extended disability, less successful outcomes and higher utilization of medical resources.3,4,5,6

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SOURCES

1 -Denniston PL, ODG Treatment in Workers’ Comp 2013, Eleventh Edition. Work Loss Data Institute, Encinitas, CA.
2 -Ballantyne JC, Shin NS. Efficacy of opioids for chronic pain: a review of the evidence. Clin J Pain. 2008;24(6):469-478.
3 -Franklin GM, Stover BD, Turner JA, et al; Disability Risk Identification Study Cohort. Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort. Spine (Phila Pa 1976) 2008;33(2):199-204.
4 -Webster BS, Verma SK, Gatchel RJ. Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery, and late opioid use. Spine (Phila Pa 1976) 2007; 32:2127-2132.
5 -Kidner CL, Mayer TG, Gatchel RJ. Higher opioid doses predict poorer functional outcome in patients with chronic disabling occupational musculoskeletal disorders. J Bone Joint Surg Am. 2009;91(4):919-27.
6 -Leider HL, Dhaliwal J, Davis EJ, et al. Healthcare costs and nonadherence among chronic opioid users. Am J Manag Care. 2011;17(1):32-40.
7 -Reed Group Disability Guidelines™, 2014, developed by the American College of Occupational and Environmental Medicine, www.mdguidelines.com/ and Denniston PL, ODG Treatment in Workers’ Comp 2013, Eleventh Edition. Work Loss Data Institute, Encinitas, CA.
8 -Livengood JM. Psychologic and Psychosocial Factors Contributing to Chronic Pain. Current Review of Pain. 1999;3(1):pp 1-9
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