Connecticut: Opioid protocols offer guidelines for practitioners

"Studies have shown that injured workers placed on high dose opioids early in the post-injury period may experience a slower recovery, more difficulty with returning to work, more difficulty with weaning, and more frequently end up on long term opioids," says the Connecticut Workers' Compensation Commission's updated medical protocols.

"It is not the intention of the WCC to restrict the proper medical use of this class of medications, however, responsible prescribing is mandatory."

The new protocols for prescribing opioids to injured workers are meant as a "guideline for the practitioner and should not supplant proper medical judgment," the protocols say. The opioid management of the injured patient includes a variety of suggestions for physicians but requires mandatory documentation of medical necessity for prescribing beyond what is described in the guidelines.

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Included in the new protocols are the following:

Low dose, short acting opioids may be appropriate during the first two weeks for those with severe injuries. However, "it is preferred that the injured worker avoid opioid medications when possible."
Immediate release, ultra-short acting sublingual and nasal opioid preparations are deemed "inappropriate" for the vast majority of injured patients while long acting opioids are not recommended in the acute and sub-acute phases of treatment.
Evaluation/consultation and treatment by a physician with "appropriate specialty training in pain management" should be considered for patients requiring opioid maintenance longer than 12 weeks.
The total daily dose of opioids should not be increased above 90mg oral morphine equivalent dose, "unless the patient demonstrates measured improvement in function, pain or work capacity."
Potential comorbidities should be evaluated before opioids are prescribed for chronic pain.
Single prescriber, single pharmacy and an opioid agreement should be used when prescribing opioids.

The protocols were developed in consultation with practitioners, insurers, and the WCC's Medical Advisory Panel.

Read more at the WorkersComp Forum homepage.

June 7, 2012

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