Through the Looking Glass: the Epidemic of Therapeutic Opioids in Workers' Compensation

• Jurisdiction: California,United States
• Citation: Vol. 28 No. 3
• Publication year: 2015
• Author: KENT H. BALL, ESQ.
• topic: Workers Compensation

Through the Looking Glass: the Epidemic of Therapeutic Opioids in Workers' Compensation

KENT H. BALL, ESQ.

Oakland, California

One pill makes you larger And one pill makes you small And the ones that mother gives you Don't do anything at all Go ask Alice When she's ten feet tall

—from "White Rabbit" by Grace Slick; Jefferson Airplane, Surrealistic Pillow, RCA Victor 1967

Drug abuse has been epidemic for years; no, decades. Remember Nancy Reagan's naive and shallow national campaign, "Just Say No"? "Get High on Life, not Drugs." "Don't Do Pot, Your Brain Will Rot." "Hugs, Not Drugs." Catchy, aren't they?

None of these campaigns or slogans is directed toward today's users or abusers of therapeutic drugs prescribed by physicians—in what might be called the New Epidemic. The death rate of overdose from prescribed opioids quadrupled between 1999 and 2010, far exceeding the combined death total from heroin and cocaine overdoses. (C.M. Jones, K.A. Mack, and L.J. Paulozzi, "Pharmaceutical overdose deaths, United States, 2010," JAMA (2013) 309: 657-9.) The problem drugs are Schedule II opioids, ones you encounter in your workers' compensation practice every day. They include oxycodone, hydrocodone, diphenoxylate, propoxyphene, fentanyl, hydromorphone, meperidine, morphine, and methadone. Among the brand names are OxyContin, Percocet, Vicodin, Lomotil, Dilaudid, Actiq, and Demerol. They are powerful drugs that create relaxed, even euphoric, feelings.

The Problem

While there are appropriate therapeutic uses for opioids, (which include both opiates, directly derived from poppies, and later-developed synthetic opioids), significant abuses are occurring in workers' compensation claims. Opiates are among the oldest known drugs, with the opium poppy predating recorded history. Opioids, in the most basic sense, are an effective and efficient analgesic (painkiller). The drugs decrease the perception of pain, decrease reaction to pain, and increase tolerance to pain. Treating physicians who prescribe these drugs are not necessarily incompetent or acting without proper motives; they are motivated to assist their patients in alleviating pain. The clinical application of opioids is invaluable in treating acute postoperative pain. There are also appropriate uses for them in managing debilitating, disabling pain in terminal conditions, such as cancer, or even chronic conditions like rheumatoid arthritis. The problem comes from the prescriptions for both short-term and chronic non-cancer pain.

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Some attribute the new epidemic to a shift in lifestyle and values. Patients want the pain to go away, and if there is an easy, legal, and (for the injured worker) free remedy, why not use it? Why should an injured worker change his or her lifestyle due to pain alone when there's an easy-to-obtain pill? The answer lies in the side effects, which include nausea, vomiting, drowsiness (anyone have a sleep disorder claim lately?), itchiness, depression (compensable consequence?), dry mouth (dental issues?), constipation (any internal claims out there?), and decreased libido (hmmm, sexual dysfunction?). Of greater concern is the decreased effectiveness of opioids after 60 days of use, according to the American College of Occupational and Environmental Medicine. Remember that opioids are extremely effective in diminishing the perception of pain but do nothing to resolve its causes. Over time, increasing the dose becomes necessary to feed this perception of pain.

The American College of Occupational and Environmental Medicine suggests a balanced approach, noting the benefits of opioids as well as offering alternatives. Early and proper treatment of all industrial injuries is the preferred approach for combatting opioid abuse. Getting injuries healed and reducing the sources of pain will eliminate much of the opioid misuse, particularly with soft-tissue injuries.

Dependence...