Reducing Risks to Injured Workers from Prescription Opioids
Every day about 500,000 injured workers are treated for chronic pain. The great majority of them will be prescribed prescription opioids, which can increase their risk of disability and fatal overdose.
Chronic use and overdoses of prescription opioids declined substantially among injured workers in Washington after the State’s Agency Medical Directors' Group (AMDG) released the nation's first opioid dosing guideline in April 2007. The average daily dose of opioids prescribed to workers dropped by 27% from 2008 to 2012 and chronic use among workers new to using opioids dropped by more than half, from 7.4% in 2004 to 3.5% in 2010. Worker deaths from overdoses of prescription opioids continued to increase through 2009, then dropped dramatically in 2010, while in the State’s overall population fatal overdoses declined by 27% between 2008 and 2012.
Using Washington’s AMDG guideline as a model, many other states have adopted prescription opioid guidelines, including Alabama, Colorado, Florida, Kentucky, Indiana, Ohio, New Mexico, New York, Oregon, Tennessee, and Utah. The Washington State Legislature passed opioid prescribing legislation based on the AMDG guideline in 2010 and in 2013 the Washington Department of Labor and Industries (DLI) implemented new rules and guidelines on opioid prescribing.
Research shows that the effectiveness of opioids is limited in treating chronic pain, and that patient risks increase dramatically with duration and dose:
- Opioid medications reduce pain by no more than 30% and decrease in effectiveness over time and with increased dose.
- Workers’ risk of being on disability at least a year increases if they receive more than a one-week supply of opioids shortly after their injury; for example, risk doubled among workers with back injuries if they received multiple prescriptions or high doses shortly after injury.
- Many fatal overdoses occur among workers who take opioids even as prescribed, at low to moderate doses for short periods of time.
As a result, the revised 2015 AMDG guideline states "there is no completely safe opioid dose." Pain experts now recommend using a variety of modalities to help injured workers suffering chronic pain.