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For those of us who work in the workers' compensation arena, 2012 will no doubt be known as the year of the Opioid Tipping Point -- a tipping point caused by the use, misuse and abuse of pain relievers and the response to reign in their use for the sake of injured workers and the financial health of our workers' comp system.

There is no debate that opioids are effective and potent analgesics widely viewed as helpful in managing moderate to severe acute pain. They were primarily developed and approved by the U.S. Food and Drug Administration for treating end-stage cancer pain. However, opioid overuse in managing the pain of injured workers and of the general population has reached epidemic proportions. To date, doctors, drug companies and patients agree that opioid pain-relieving drugs are the answer for treating pain: but with the epidemic use of opioids and the resulting related problems of addiction and diversion -- that paradigm needs to change.

Reading a quick primer on pain medications would tell you that opioids are the synthetic versions of the naturally derived narcotics made from opium, which are called opiates. Opioids are partially or entirely synthetic and are commonly known by the drug names Oxycodone, Fentanyl, Morphine, Methadone, Hydromorphone, Oxymorphone, Levorphanol, Meperidine and Codeine. The worst consequence of consuming opioids is that they can cause addiction and overdose, which can lead to permanent injury such as brain damage, or even n sudden death. Opioids are central nervous system depressants. When suppressed too far by depressants, heart and lung functions can slow down and eventually stop.

Despite the dire consequences of consuming opioids over a long time and in large quantities, opioid use has exploded over the last 10 years. Industry stakeholders who have tracked the opioid explosion have now grabbed the media attention and most importantly have convinced the industry that opioids are creating havoc not only in society but in our workers' comp programs.

Ugly Opioid Statistics

There is no shortage of ugly statistics associated with opioid use, misuse and abuse in the general population and in workers' comp programs: Peter Rousmaniere's January 24th column in Risk & Insurance®, "How Many Injured Workers Die from Opioids?" also contained many of these eye-opening statistics.

* Since 2003, more overdose deaths have involved opioid analgesics than heroin and cocaine, according to the Centers for Disease Control and Prevention.

* 1.2 million emergency department visits were related to misuse or abuse of opioids; more than of all illegal drugs combined, according to the CDC.

* In 2010, enough opioids were prescribed to medicate every American adult with a typical dose of 5 milligrams of hydrocodone every four hours for three weeks, according to the CDC.

* 70 percent of nonmedical users report getting drugs that had been prescribed to someone else, and only 20 percent report that they acquired the drug from their own doctor, according to the U.S. Department of Health and Human Services.

* Opioid abuse has been demonstrated in 9 percent to 41 percent of patients receiving chronic pain management, according to the National Institute on Drug Abuse.

* Nationwide, 3 percent of doctors account for 62 percent of prescribed opioids pain relievers, according to the CDC.

* Opioid painkiller OxyContin is the most prescribed drug in workers' comp, according to the CDC.

These ugly statistics were generated by our U.S. medical system -- including our workers' comp programs gone awry. Physicians believed they were doing the right thing by prescribing effective pain relievers to patients. Other physicians went rogue, learning that they could become very wealthy operating pain clinics and peddling opioids to addicted individuals.

Industry pain experts agree most of the challenge in reigning in the use and abuse of opioids is in prescriber and patient education. The challenge facing physicians is to understand the difference between acute pain, which is pain resulting from injury and surgery during the initial injury period, and chronic pain which occurs after the healing process has substantially completed.

According to Gary Mills, founder of Pacifica Pain Management Services, not only are doctors struggling to distinguish acute from chronic pain, and chronic pain from chronic pain syndrome, they are also struggling to differentiate biomedical from biopsychosocial treatments that are often key to healing workers' comp injuries.

Acute-stage pain from an injury lasts one to three months, subacute-stage pain from three to six months, and chronic-pain syndrome is seen at greater than six months. As pain science has evolved, experts like Mills have proven that during the acute stage, treatment should include appropriate medications, rest and sometimes surgery.

Beyond the acute-pain stage, a multidisciplinary biopsychosocial approach employing physical/cognitive rehabilitation, stress management, pain threshold alteration, perceptual changes and even detox, if addicted to pain medication, is the best course to follow. Unfortunately, according to pain gurus like Mills, keeping workers' comp and other injured patients on opioids through all three stages of pain, is actually detrimental to the body's natural healing process and simply causes addiction and dependence.

(Next month, I will highlight some state successes and failures in reining in the use of opioids, as well as offer free physician resources that can be tapped to tackle the problem.)

MARK NOONAN is a managing principal and the senior knowledge manager for workers' compensation for the Casualty Practice within Integro Insurance Brokers.

February 9, 2012

Copyright 2012© LRP Publications