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Abstract
The duration of opioid therapy after surgery is the strongest known predictor of ultimate misuse, and researchers have reported that the number of days for which medication was prescribed and the total number of postoperative prescriptions each predicts long-term use. This article addresses the question of rating the impairment for an individual with no history of substance use disorder before a work injury, who is prescribed opioids for this injury, and who subsequently develops opioid use disorder (OUD). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, should be used in conjunction with the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Sixth Edition. A person who is prescribed opioids is not yet at maximum medical improvement (MMI) and cannot be rated. Referral for substantiation of the diagnosis and for initiation of treatment are necessary before OUD is confirmed and the patient is at MMI. The AMA Guides is based on impairments of activities of daily living (ADL), so a patient's MMI should result in a happy outcome and no impairment, although the burden of treatment compliance may be a relevant consideration. The article concludes with an extensive literature review, including abstracts of published articles regarding OUD in various settings.
- Abstract
- References
- IN THE LITERATURE: Opioid Use Extracts
- 1. Prevalence and Risk Factors Associated With Long-Term Opioid Use After Injury Among Previously Opioid-Free Workers
- 2. Prescription Opioid Use by Injured Workers in Tennessee: A Descriptive Study Using Linked Statewide Databases
- 3. Opioid and Benzodiazepine Use Before Injury Among Workers in Washington State, 2012 to 2015
- 4. Implementation of an Opioid Guideline Impacts on Opioid Prescriptions, Adverse Outcomes, and an Association With a State Opioid-Related Fatalities
- 5. Opioid Prescribing After Surgery in the United States, Canada, and Sweden
- 6. Association Between Concurrent Use of Prescription Opioids and Benzodiazepines and Overdose: Retrospective Analysis
- 7. Strategies to Identify Patient Risks of Prescription Opioid Addiction When Initiating Opioids for Pain: A Systematic Review
- 8. Opioids for Low Back Pain
- 9. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial
- 10. Preoperative Opioids and 1-year Patient-Reported Outcomes After Spine Surgery
- 11. Prescription Opioid Type and the Likelihood of Prolonged Opioid Use After Orthopaedic Surgery
- 12. Prediction of Complications, Readmission, and Revision Surgery Based on Duration of Preoperative Opioid Use
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Durand Z, Nechuta S, Krishnaswami S, Hurwitz EL, McPheeters M. Prescription opioid use by injured workers in Tennessee: a descriptive study using linked statewide databases. Ann Epidemiol. 2019;32:7–13.
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2.
Brat GA, Agniel D, Beam A, et al.Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study. BMJ. 2018;360:j5790. http://dx.doi.org/10.1136/bmj.j5790. Accessed Jan 23, 2020.
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Fitzgibbon DR, Rathmell JP, Michna E, Stephens LS, Posner KL, Domino KB. Malpractice claims associated with medication management for chronic pain. Anesthesiology. 2010;112:948–956.
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Shah A, Hayes CJ, Martin BC. Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017;66:265–269. http://dx.doi.org/10.15585/mmwr.mm6610a1. Accessed Jan 23, 2020.
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Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL. Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg. 2017;152(11):1066–1071. doi: 10.1001/jamasurg. Accessed Jan 23, 2020.
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Sabatino MJ, Kunkel ST, Ramkumar DB, et al.Excess opioid medication and variation in prescribing patterns following common orthopaedic procedures. J Bone Joint Surg Am. 2018;100:180–188. http://dx.doi.org/10.2106/JBJS.17.00672. Accessed Jan 23, 2020.
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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. American Psychiatric Association: Washington, DC; 2000.
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American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association: Washington, DC; 2013:541.
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Barth RJ. Prescription narcotics: an obstacle to maximum medical improvement. Guides Newsletter. American Medical Association: Chicago, IL; March/April 2011.
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Maglione MA, Raaen L, Chen C, et al.Effects of medication-assisted treatment (MAT) for opioid use disorder on functional outcomes: a systematic review. Rand National Defense Research Institute: Santa Monica, CA; 2018. https://www.rand.org/pubs/research_reports/RR2108.html. Accessed Jan 23, 2020.
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Hyman SE, Malenka RC, Nestler EJ. Neural mechanisms of addiction: the role of reward-related learning and memory. Annu Rev Neurosci. 2006;29:565–598.
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US Surgeon. Chapter 2: The Neurobiology of Substance Use, Misuse, and Addition. In: Surgeon General's Report. https://addiction.surgeongeneral.gov/sites/default/files/chapter-2-neurobiology.pdf. Accessed Nov 13, 2019.
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