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The National Council on Compensation Insurance published its first article on a series focused on Opioids.

This series is aimed at exploring three viewpoints on issues surrounding opioid use and workers compensation: those of doctors, insurers, and workers compensation regulators. NCCI conducted interviews with professionals from each of these areas and the articles in this series reflect their opinions on the topic.

In this first of a three-part series, it reported the views from several doctors in the workers compensation system.

Given the serious risks associated with opioids, including the potential for addiction and overdose, the physicians it interviewed agreed that it is the responsibility of the treating practitioner to prescribe opioids with care and to use evidence-based guidelines.

These guidelines outline when to prescribe opioids, as well as recommend the appropriate drug dosage. When prescribing an opioid, the treating physician must provide the patient with an accurate diagnosis, honest communication, and clinical expertise.

In recent years, however, prescribers have come under scrutiny for prescribing excessive amounts of opioid painkillers and, as a result, they are more careful in their practices.

The doctors that were interviewed also agreed that narcotics in general, and opioids specifically, became a first line of treatment for pain management. Only recently has there been careful evaluation of the potential for addiction and overdose.

Like most epidemics, the beginning is only clear in hindsight. According to the physicians we spoke with, significant marketing efforts to promote opioids and what may be characterized by some as controversial scientific research began a cultural shift for many physicians, starting with a study in the mid-1980s that addressed the use of opioids for pain relief.

The physicians said that seemingly, a new culture formed around the practice of pain management. That culture was further propelled in 2001, when the Joint Commission released new pain management standards, including the idea that pain is a vital sign, like body temperature and heart rate. These new standards perpetuated the notion that pain must be treated – it no longer needed to be endured, one doctor recalled. Pain itself was now viewed as a disease, and opioids became the supposed low-risk cure.

Within the workers compensation system, claimants in the coal industry became some of the first to feel the effects of these deemed “miracle drugs,” according to one doctor. Doctors and industries in West Virginia and Kentucky became the target of opioid marketing efforts. Those receiving the sales pitches were assured that new formulas for the extended-release opioid products were less likely to become habit-forming or result in addiction. Additionally, certain groups cashed in on not only dispensing huge quantities of opioids and other addictive drugs, but some doctors even scheduled visits with patients from out of state.

Within the workers compensation system, the doctors said they may have more influence with a patient who is veering toward opioid dependence or addiction – especially if the injured worker believes they may lose their benefits if they do not adhere to the agreed-upon treatment plan. Importantly, the doctors all noted that addressing psychosocial issues and fully understanding the patient’s sources of pain are crucial to getting the injured worker on a path to recovery.