Guideline for Prescribing Opioids to Treat Pain in Injured Workers

Mai, Jaymie; Franklin, Gary M.; Tauben, David

doi:10.1016/j.pmr.2015.04.005

Cited by 16 publications

(23 citation statements)

References 36 publications

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“…Demanding physical work, high psychosocial work demands, excessive repetition of tasks, awkward postures, and heavy lifting are all known workplace risk factors for musculoskeletal pain in prospective studies . Such injuries are routinely treated with high doses and long‐term prescriptions for opioids despite the publication of clinical practice guidelines that caution against routine use . Prescribing rates and doses of opioids are higher in workers compensation insurance claims that they are in private insurance claims .…”

Section: Introductionmentioning

confidence: 99%

Opioid‐related overdose deaths by industry and occupation—Massachusetts, 2011‐2015

Hawkins

Roelofs

Laing

et al. 2019

American J Industrial Med

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Background: Thousands of people in the United States continue to die from opioid overdoses every year. Work-related injuries and other factors associated with work may increase exposure to opioids and, subsequently, opioid-related overdose deaths (OROD).This study sought to determine whether OROD rates differed by industry and occupation and explored work-related factors that might contribute to these differences. Methods:We coded industry and occupation information on death certificates for all OROD among Massachusetts residents from 2011 to 2015. We estimated rates of OROD by industry and occupation using Massachusetts employment data. National survey data were used to explore whether work-related factors known to vary by occupation (occupational injury and illness, job insecurity, and paid sick leave) correlate to observed differences in OROD.Results: Several industries and occupation groups had rates of OROD that were significantly higher than the rates for other workers. Construction workers and fishing workers stood out for having OROD rates many times higher than the average for all workers. Occupation groups with high rates of occupational injuries and illnesses, high job insecurity, and low availability of paid sick leave had higher rates of OROD.Conclusions: These findings underscore the need for policy and educational interventions to reduce OROD tailored to the needs of high rate worker populations. Interventions should address workplace hazards that cause injuries for which opioids are prescribed, as well as best practices in medical management and return to work following injury, safer prescribing, enhanced access to treatment for opioid use disorders, and overdose prevention education.

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Section: Introductionmentioning

confidence: 99%

Opioid‐related overdose deaths by industry and occupation—Massachusetts, 2011‐2015

Hawkins

Roelofs

Laing

et al. 2019

American J Industrial Med

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“…2,10 Alternatively, opioids may have been used long-term if improved symptoms were observed. 4,7,9 These data suggest that although both classes are primarily recommended for acute pain (or for cautionary long-term use when there is symptom improvement) and both have serious long-term risks, opioids appear to be used more extensively for long periods. The study findings are limited by their observational nature and the representation of a single health system.…”

Section: Discussionmentioning

confidence: 99%

“…6 Within the context of these known risks and recommendations to use both classes primarily for acute pain (except cautionary use for select conditions when there is clear longitudinal symptom improvement), it is unclear how often opioids and NSAIDs are prescribed long-term despite potential risks. 6–9 This study compares long-term use of both classes for patients with non-cancer low back pain in a large healthcare system.…”

Section: Introductionmentioning

confidence: 99%

Long-term Management of Low Back Pain with Opioids and Non-steroidal Anti-inflammatory Drugs in a Health System

Ahmedani

Peterson

Wells

et al. 2016

American Journal of Preventive Medicine

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“…Various groups have independently developed guidelines for the prescribing of opioids for management of acute pain in emergency rooms (del Portal et al, 2016) and for the management of pain in acutely injured workers (Mai et al, 2015). In one study, del Portal and colleagues (2016) found that opioid prescribing decreased significantly in an acute care setting (from 52.7 percent before the guideline was issued to 29.8 percent immediately after its introduction, and to 33.8 percent 12 to 18 months later) based on retrospective chart review for more than 13,000 patient visits.…”

Section: Opioids and Acute Pain Managementmentioning

confidence: 99%

Pain Management and the Opioid Epidemic

Bonnie¹,

Ford²,

Phillips³

2017

102

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Years of sustained, coordinated, and vigilant effort will be required to contain the present opioid epidemic and ameliorate its harmful effects on society. At least 2 million people have an opioid use disorder (OUD) involving prescription opioids, and almost 600,000 have an OUD associated with heroin (HHS, 2016). These numbers are likely to increase in the coming years, regardless of what policies are put in place. Follow-up studies of individuals receiving treatment for OUD involving heroin (e.g., Hser et al., 2001) find very high rates of premature mortality (in the neighborhood of one-third) due to overdose or other complications of the disorder. Thus, even if the nation ramps up treatment availability substantially and immediately, death rates will climb and quality of life will be dramatically reduced for many people for years to come. Likewise, the continued progression of still more people from prescription opioid use to OUD will demand sustained and coordinated effort to establish and implement the scientifically grounded policies and clinical practices necessary to reshape prescribing practices and reduce the occurrence of new cases of prescription opioid-induced OUD. 1 What should be done to contain the opioid epidemic and to prevent new cases of iatrogenic addiction and associated overdose, death, and other harms? The purpose of this chapter is to review available evidence on strategies that have been used to address the problems of opioid misuse, OUD, 1 Vigilance will also be needed to reduce the risk of similar problems in the future with other classes of medications for which there exists demand for clinical uses other than the indicated conditions and/or active black markets for their resale. 269RCTs, however, are rare for policies that require implementation at the level of an entire jurisdiction, nor are they ethically permissible in many policy contexts. In the absence of RCTs, other sources of evidence are needed to estimate the counterfactual outcome distribution under different strategies. One such source of evidence is the collection of data on individuals who happen to receive the strategies of interest as part of their routine care, often from electronic health records. The so-called observational analyses based on such data are attempts to emulate the RCT that cannot be conducted (the target trial). In these observational analyses, however, the comparability of the groups receiving each strategy is not guaranteed. In the real world, for example, the restricted opioid prescription policy might more likely be applied to individuals visiting providers in urban health care settings who also received other interventions to reduce the risk of addiction. As a result, a direct comparison of the outcome distribution between those who received each strategy would be confounded by the concomitant interventions.Observational analyses attempt to eliminate bias due to confounding by adjusting for all measured prognostic factors that are distributed differentially between the groups. For example, the ...

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Guideline for Prescribing Opioids to Treat Pain in Injured Workers

Cited by 16 publications

References 36 publications

Opioid‐related overdose deaths by industry and occupation—Massachusetts, 2011‐2015

Opioid‐related overdose deaths by industry and occupation—Massachusetts, 2011‐2015

Long-term Management of Low Back Pain with Opioids and Non-steroidal Anti-inflammatory Drugs in a Health System

Pain Management and the Opioid Epidemic

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