A Healthesystems publication

Spring 2015

The best formula for abuse deterrence: Comprehensive pain management strategy

Rather than trying to apply a “fast fix” for abuse through the prescribing of abuse-deterrent opioids, prescribers must address the underlying factors that contribute to prescription medication abuse. Adoption of a comprehensive, evidence-based pain management program will support the complex needs of the injured worker in their path to functional rehabilitation.

The inability to significantly impact abuse through the prescribing of abuse-deterrent technology is rooted in the very nature of opioid analgesics. As long as these medications continue to act as they are intended — relief of pain by binding to opioid receptors of the brain, which in turn provides a feeling of euphoria — there will always be a potential for abuse. The greatest limitation of current abuse-deterrent technologies is that they do not address the underlying causes for abuse, which include dependence and addiction. These are best addressed by limiting opioid prescribing in the injured worker, and instead developing a comprehensive pain management plan tailored to a patient’s needs that includes both pharmacologic and non-pharmacologic components.


Evidence-based guidance rarely recommends the use of long-term opioid therapy in the treatment of the injured worker, yet 9 million people in the United States report chronic opioid use for medical reasons.1 With this overutilization of long-term opioid narcotics, it is unsurprising that 7 out of 10 pharmaceutical drug overdose deaths involve these medications.2

Too often narcotic analgesics are prescribed as an easy fix. But evidence shows that they aren’t truly fixing anything. Long-term treatment with opioids is associated with poorer functional outcomes, including longer duration of disability.3-5 Achievement of better outcomes requires a better strategy. The road to recovery for the injured worker is often not easy, but extraordinarily complex. A successful treatment strategy must be comprehensive enough to address the many needs of the injured worker, whether those needs are physical or psychosocial. It must also take into consideration the individual challenges faced by each unique patient. 



1 -Centers for Disease Control and Prevention (CDC). CDC grand rounds: prescription drug overdoses – a U.S. epidemic. MMWR Morb Mortal Wkly Rep. 2012;61(1):10-3.
2 -Centers for Disease Control and Prevention. National Vital Statistics System mortality data. (2015) Available from http://www.cdec.gov/nchs/deaths.htm . Accessed April 7, 2015.
3 -Franklin GM, Stover BD, Turner JA, et al. 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;32:2127-32.
5 -Kidner CL, Mayer TG, Gatchel RJ. Higher opioid doses predict poorer functional outcomes in patients with chronic disabling occupational musculoskeletal disorders. J Bone Joint Surg Am. 2009;91(4):919-27.
6 -PDMP Center of Excellence at Brandeis University.
7 -Healthesystems clinical findings.
8 -Lind BK, Lafferty WE, Tyree PT, et al. Comparison of health care expenditures among insured users and nonusers of complementary and alternative medicine in Washington state: a cost minimization analysis. J Alt Comp Med. 2010;16(4):411-7.
9 -Martin BC, Fan M-Y, Edlund MJ, et al. Long-term chronic opioid therapy discontinuation rates from the TROUP study. J Gen Intern Med. 2011;26(12):1450-7.
10 -Leider HL, Dhaliwal J, Davis EJ, et al. Healthcare costs and nonadherence among chronic opioid users. Am J Manag Care. 2001;17(1):32-40.
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