Rating Opioid Use Disorder for Permanent Impairment
James B. Talmage
Search for other papers by James B. Talmage in
Current site
Google Scholar
PubMed
Close
Restricted access

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.

  • 1.

    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;32:713.

    • Search Google Scholar
    • Export Citation
  • 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.

    • Search Google Scholar
    • Export Citation
  • 3.

    Fitzgibbon DR, Rathmell JP, Michna E, Stephens LS, Posner KL, Domino KB. Malpractice claims associated with medication management for chronic pain. Anesthesiology. 2010;112:948956.

    • Search Google Scholar
    • Export Citation
  • 4.

    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;66:265269. http://dx.doi.org/10.15585/mmwr.mm6610a1. Accessed Jan 23, 2020.

    • Search Google Scholar
    • Export Citation
  • 5.

    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):10661071. doi: 10.1001/jamasurg. Accessed Jan 23, 2020.

    • Search Google Scholar
    • Export Citation
  • 6.

    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;100:180188. http://dx.doi.org/10.2106/JBJS.17.00672. Accessed Jan 23, 2020.

    • Search Google Scholar
    • Export Citation
  • 7.

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. American Psychiatric Association: Washington, DC; 2000.

    • Search Google Scholar
    • Export Citation
  • 8.

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association: Washington, DC; 2013:541.

    • Search Google Scholar
    • Export Citation
  • 9.

    Barth RJ. Prescription narcotics: an obstacle to maximum medical improvement. Guides Newsletter. American Medical Association: Chicago, IL; March/April 2011.

    • Search Google Scholar
    • Export Citation
  • 10.

    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.

    • Search Google Scholar
    • Export Citation
  • 11.

    Hyman SE, Malenka RC, Nestler EJ. Neural mechanisms of addiction: the role of reward-related learning and memory. Annu Rev Neurosci. 2006;29:565598.

    • Search Google Scholar
    • Export Citation
  • 12.

    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.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 36 36 3
Full Text Views 25 25 0
PDF Downloads 0 0 0
Save