Tag Archives: opioids

Educate Stakeholders on Effective Alternatives to Opioids

September 12, 2018 by 

A combination of ibuprofen and acetaminophen does a better job of relieving acute pain than opioids. Despite clear evidence that the combination of the less dangerous medications provides equal or greater pain relief, many physicians still prescribe opioids for injured workers with pain.

Doctor holding a note that reads, "Explore non-Opioid Alternatives" for article, Educate Stakeholders on Effective Alternatives to OpioidsThis statement was just one point made in a recent session at the Workers’ Compensation Institute’s Annual Conference in Orlando presented by:

  • Marcos A. Iglesias, Chief Medical Officer of Broadspire
  • Mark Pew, senior VP for Product Development & Marketing at Preferred Medical.

The Problem

The opioid epidemic in the U.S. has been well documented in recent years. Researchers say Americans consume more opioids than any other country, regardless of the myriad physical and psychological problems associated with their unnecessary use.

While stakeholders in the workers’ compensation system have made progress in curbing the unnecessary use of opioids in recent years, it will take a concerted effort of educating providers as well as employees about chronic pain, and effective treatment alternatives said Iglesias and Pew.

Findings released by the Society for Internal Medicine on a one-year comparison of patients with chronic low back pain who were treated with either opioids or ibuprofen included:

  • No difference in function
  • Those given opioids had statistically worse pain control

Among the side effects of opioids are

Can An mHealth Kit Improve Outcomes in Workers Comp Treatment?

Cedars-Sinai will be testing a digital pain reduction kit, which includes VR glasses and mHealth wearables, to see if mobile health technology can replace opioids for people recovering from workplace injuries.

 By Eric Wicklund

 – Cedars-Sinai Medical Center is participating in a study to determine whether an mHealth kit containing wearables and a pair of virtual reality glasses can help people suffering from work-related injuries recover more quickly and without the use of opioids.

patient in hospital wearing VR glasses for article, Can An mHealth Kit Improve Outcomes in Workers Comp Treatment?

Researchers at the Los Angeles hospital are partnering with Samsung Electronics America, Bayer, appliedVR and The Travelers Companies for the 16-mointh study, which will put the “digital pain-reduction kit” in the hands of between 90 and 140 participants.

“Workplace injuries that lead to chronic pain can cause ongoing issues, as an injured employee may mask pain with opioids or other drugs,” Dr. Melissa Burke, Travelers’ National Pharmacy Director, said in a press release. “

Identifying new, non-pharmacologic alternatives for pain reduction  can help an injured employee avoid chronic pain, lower the chances that they will develop a dangerous opioid addiction and reduce medical costs.”

Led by Brennan Spiegel, MD, MSHS, Director of Health Services Research for Cedars-Sinai and a professor of medicine and public health at UCLA, Cedars-Sinai has been one of the leadersin studying the application of virtual reality tools and other mHealth devices in healthcare, focusing particularly on digital therapeutics.

Continue reading Can An mHealth Kit Improve Outcomes in Workers Comp Treatment?

Prescribed DUI: An Alcohol-Free Danger

AKA: Tiger Woods  Syndrome

06/12/17    Dr. Paul Peak

Rx prescription pad with the words, "Don't Drive!"When it comes to getting the attention of the media and the public, not many things work better than an unfiltered, celebrity mugshot. When Tiger Woods was arrested on Memorial Day for driving under the influence, his mugshot and the story of his arrest became easy fodder for the media.

The man once known for being unstoppable on the golf course was found in a stopped car, asleep in the early hours of the morning. While it is easy to assume that anyone arrested for a DUI with a rough looking mugshot like Tiger’s must have been drinking, this was reportedly not the case with Tiger. And it may have been hard to believe when Tiger himself dismissed alcohol as the culprit early on after the news broke. Yet according to the police report, Tiger blew a .000 on his breathalyzer. Tiger was not driving drunk. Tiger was driving drugged. And drugged driving can be just as deadly.

While it’s unclear exactly what regimen Tiger was taking or what drugs led to the interaction (some of the drugs listed on the police report are incorrect as they either don’t exist, are amazingly misspelled, or have been off the market since 2004), this appears to be another example of strong medications used in combination impairing one’s ability to drive.

The one drug listed on the police report that is currently available by prescription only and recognizable is Vicodin, or otherwise known in generic form as hydrocodone in combination with acetaminophen (Tylenol). Vicodin, a commonly prescribed opioid, is known to cause drowsiness, something that is only amplified when given with other medications like a muscle relaxant (a type of medication commonly prescribed after back surgery which Tiger had last month).

Continue reading Prescribed DUI: An Alcohol-Free Danger

Even Small Quantities of Opioids Prescribed for Minor Injuries Increase Risk of Long-Term Use

Source: Perelman School of Medicine at the University of Pennsylvania
May 17, 2017

short term opioid use rish graphOverprescribing of opioid medications for pain has contributed to a record-high number of drug-related deaths in the United States in recent years. A significant part of the issue, experts say, is the vast amount of variation in opioid prescribing habits for minor injuries such as ankle sprains — which don’t require treatment with such risky drugs in the first place.

For example, patients who received their first opioid prescription for an ankle sprain treated in U.S. emergency departments (EDs) commonly received prescriptions for anywhere from 15 to 40 pills, according to new research from the Perelman School of Medicine at the University of Pennsylvania.

Those who received 30 or more pills compared to less than 15 pills were twice as likely to fill an additional opioid prescription within three to six months. The authors say the results point to the urgent need for policies and guidelines to address when opioid medications are indicated for minor injuries and to reduce the number of pills supplied for opioid prescriptions. The study will be presented today during the plenary sessions at the Society for Academic Emergency Medicine annual meeting in Orlando, FL.

“The substantial variation in prescribing patterns of such extremely addictive medications for minor injuries results in many thousands of pills entering the community, and places patients at an increased risk of continued use and potentially addiction,” said lead author M. Kit Delgado, MD, MS, an assistant professor of Emergency Medicine and Epidemiology at Penn. “It’s vital that we identify and understand the root causes of this growing issue.”


Medical Marijuana – Without Any Marijuana!

By WorkCompAcademy.com 11/29/2016

Medical Marijuana logoSacramento, CA – The workers’ compensation community is bracing for the potential, and some say eventual, tidal wave of claims for medical marijuana as a form of treatment for pain related industrial injuries. But soon it may be possible to provide the claimed benefits of “medical” marijuana – without any marijuana at all!

Science Daily reports that Indiana University neuroscientist Andrea Hohmann took the stage at a press conference Nov. 14 in San Diego to discuss research conducted at IU that has found evidence that the brain’s cannabis receptors may be used to treat chronic pain without the side effects associated with opioid-based pain relievers or medical marijuana.

The study was discussed during the annual meeting of the Society for Neuroscience, the world’s largest source of emerging news about brain science and health. Hohmann was joined by three other international researchers whose work focuses on similar topics.

“The most exciting aspect of this research is the potential to produce the same therapeutic benefits as opioid-based pain relievers without side effects like addiction risk or increased tolerance over time,” said Hohmann, a Linda and Jack Gill Chair of Neuroscience and professor in the IU Bloomington College of Arts and Sciences’ Department of Psychological and Brain Sciences.

Chronic pain is estimated to affect nearly 50 million adults in the United States. The rise in opioid-based pain relievers to treat chronic pain has also contributed to an opioid addiction epidemic in the United States, with 19,000 deaths linked to prescription opioid abuse in 2014. In Indiana, the use of needles associated with prescription opioid abuse led to a major HIV outbreak in the state’s southeastern region, prompting the governor to declare a public health emergency in 2015.

 Continue reading Medical Marijuana – Without Any Marijuana!

Urine Big Trouble: OSHA Clarifies Circumstances Under Which Post-Accident Drug Testing Violates Federal Law

By National Workers Compensation Defense Network (NWCDN) 11/11/2016

urine testing chart and sample bottleThis month the Occupational Safety and Health Administration issued a memorandum which seeks to clarify the extent to which OSHA will consider post-accident drug and alcohol testing to be a violation of federal regulations.

The memorandum addresses questions that have arisen about a rule that OSHA published in May. That rule, theElectronic Recordkeeping Rule, prohibits retaliation against employees who report workplace injuries and illnesses.

In comments to that rule OSHA previously stated that the rule “does prohibit employers from using drug testing (or the threat of drug testing) as a form of adverse action against employees who report injuries or illnesses.” Those comments ignited a firestorm, and since then there has been debate as to whether all post-accident drug or alcohol testing is now prohibited.

In the new memorandum, dated October 19, 2016, OSHA’s answer to that question is “no.” It explains that the rule does not prohibit  employers from drug testing employees who report work-related injuries “so long as they have an objectively reasonable basis for testing.” Continue reading Urine Big Trouble: OSHA Clarifies Circumstances Under Which Post-Accident Drug Testing Violates Federal Law

Reimagine the Experience of an Injured Worker

Photo of Becky Curtis, founder of Take Courage Counseling
Becky Curtis, founder of Take Courage Counseling

By Safety National 09/29/2016 03:56:00

At the 2016 IAIABC Annual Convention, Becky Curtis, founder of Take Courage Counseling, talked about how the workers’ compensation system can enhance the experience of injured workers.

Years ago, Becky suffered a horrible automobile accident that resulted in a fractured spine and left her as an incomplete quadriplegic. After the accident, she spent most of the first year in a wheelchair while undergoing extensive rehabilitation. She had to learn to walk again and perform activities of daily living. She was eventually pronounced at maximum medical improvement and discharged from care as her condition stabilized.

Chronic pain was part of her everyday life at that point. As the chronic pain worsened, the physicians discovered she had developed a syrinx at the level of her spinal fracture. This was not operable, so the physicians treated the condition with high doses of narcotic pain medications. She developed severe depression due to the chronic pain and inability to effectively manage it.

Eventually they decided to try a functional restoration program with the hope that would give her pain relief. It was during this program that she experience a paradigm shift and came to the understanding on how the brain controlled sensations of pain. This paradigm shift made her realize that, instead of waiting for someone else to take care of her, she needed to take control of her own life and recovery. There was no magical pill that was going to cure her pain. Instead she had to change her attitude about her pain and disability. Continue reading Reimagine the Experience of an Injured Worker

Chronic Pain: A Double Dose of Trouble

September 13, 2016 by Michael B. Stack

chronic pain instagraphicDealing with “chronic pain” is an issue the workers’ compensation claims management team deals with on a daily basis.

This is highlighted by the daily dose of news about the prescription drug epidemic and the countless Americans who are either addicted to these legal medications, or become addicted to street drugs as the result of using them to deal with work-related injuries.  It is important to claim handlers to be proactive on this issue for the benefit of the injured employee and the bottom line.

What is Chronic Pain?

From a clinical standpoint, “chronic pain” is pain symptomology that lasts from three to six months following the onset of injury.  This can be the result of a specific incident such as a slip/fall injury, an aggravation or acceleration of an underlying condition or an injury resulting from workplace exposure or repetitive activity.

In most incidents, healthcare professionals in the United States deal with chronic pain by prescribing opioid-based pain medications.  These medications come in many forms and names people have come to know.  They include:

•  Codeine (available in generic form)
•  Fentanyl (Actiq, Duragesic, Fentora)
•  Hydrocodone (Hysingla ER, Zohydro ER)
•  Hydrocodone/acetaminophen (Lorcet, Lortab, Norco, Vicodin)

These prescriptions are useful as they relieve pain for a period and allow a person to recover from injury.  They are derived from opium, which is commonly processed into the street drug known as heroin. |

Quick Facts on Opioid Addiction

•  From 2000 – 2013, the drug screening industry grew by $1.2 billion.Workers’ compensation insurers in California alone spend about $100 million per year for opioid-based pain medications.


Advancing Pain Treatment

By Safety National 08/24/2016 10:59:00

Chroni Pain signStartling statistics, trends and illustrations reveal an undeniable prescription drug problem in the United States.

This session at WCI’s 2016 Workers’ Compensation Educational Conference focused on chronic pain management, including alternative and advanced treatment methods being used to alleviate pain and restore quality of life among those who have become ill or have been injured on the job.

Speakers included:
•  Dr. Teresa Bartlett, Senior Vice President, Medical Quality, Sedgwick
•  Michael Gavin, CEO, Prium
•  Dr. Eric Won, President, Brain Research Laboratory

Opioids and other powerful narcotics are often the first line of defense in addressing chronic pain among injured or ill workers today. Far too often, these lead to the more severe problems of long-term use and addiction. The lives of workers and those around them can quickly be destroyed.

There are several ways to intervene when an addiction occurs:

•  PBM-assisted triage and collaborative clinical intervention. Offer provider education on CDC guidelines and follow best practices related to opioid risk assessments and drug screening.
•  Pain coaching and behavioral support.
•  Mandatory utilization review, when applicable. If you can stop the prescription at the point of sale, you have the best chance of avoiding potential problems later on.
Continue reading Advancing Pain Treatment

A New Opioid … Really?

By Mark Pew 08/09/2016

cereal bowl full of multi-colored prescription pillsAccording to the Philadelphia’s “The Inquirer”, Medical advisers to the FDA have recommended approval of a new abuse-deterrent formulation (ADF) opioid named Arymo ER by Egalet Corp.

In fact, the vote was overwhelming; 18-1. This new painkiller is an extended-release morphine that comes in 15mg, 30mg and 60mg doses. A final decision by the FDA on that recommendation is expected by mid-October.

When compared to MS-Contin, a pharmacologist with the FDA reportedly said …

The numerical difference or outcome in the data was less than 5 percent, raising a question about Arymo’s “clinical relevance”
I applaud the concept of abuse-deterrence formulations of opioids and other dangerous drugs that can be abused. I appreciate the fact there truly are some people that need opioids for “before/during/immediately after surgery, cancer, AIDS/HIV, end-of-life care” (my broadbrush interpretation of appropriate use of opioids). I agree abuse (non-medical use) is rampant with opioids (and other dangerous drugs). I am an “all of the above” (all options on the table) kind of person when it comes to resolving our painkiller epidemic, and I do think ADF has a part to play.

But to me the bigger problem is … legitimate prescriptions by legitimate prescribers used legitimately by patients that are clinically inappropriate. Especially for the mostly inappropriate treatment of chronic pain.