The increasingly severe epidemic of overuse, abuse, and death involving prescription narcotics is of specific relevance to workers’ compensation, which is the primary venue for use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). Because of the scientific knowledge base regarding prescription narcotics for chronic benign pain, evaluators may question how any patient could credibly be considered to have reached maximum medical improvement (MMI) if that patient has a prescription for a narcotic. Hyperalgesia associated with narcotics does not appear to be permanent, but evidence indicates that prescription narcotics cause significant problems in addition to worsening pain: endocrine disruption, sleep abnormalities, immune system compromise, cognitive impairment, substance abuse, and generalized ill health and disability, among others. Evaluators may worry that refusing to evaluate a person who is not at MMI because they are receiving a prescription narcotic may unintentionally delay resolution of the person's claim. In a more efficient approach, an evaluator could undertake the complete evaluation process, including creating an impairment rating, and document in the evaluation report that the rating is being provided despite reasons to be concerned that the impairment is artificially inflated in a nonpermanent way by the unjustifiable narcotic prescription. Evaluators should not state that the impairment from side effects of the opioids is permanent.

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