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Joseph A. Hirsch
,
Steven Mandel
,
Kurt T. Hegmann
,
Alexandra G. Stratyner
,
Stuart Gitlow
,
James B. Talmage
, and
Christopher R. Brigham

from 2020. More than 70% of these fatalities were caused by opioid overdose, most involving synthetic opioids other than methadone. Cocaine and psychostimulants also contributed to increasing drug overdose deaths (approximately 17% of the total in 2021). For the first half of 2020, there were almost 3,000 fatal overdoses owing to benzodiazepines, with 92.7% also involving opioids. 3 The enormous surge in morbidity and mortality associated with drug use and addiction piqued our curiosity. The characterization of drug addiction as a chronic, relapsing disease of the

in AMA Guides® Newsletter
James B. Talmage

person is still being prescribed opioids despite the prescribing provider's records documenting issues of frequent early refills, “lost” prescriptions, failed pill counts, and noncompliant urine drug tests, and if this person has not had a trial of treatment by an addictionologist or a psychiatrist who has certification for addiction assessment and medication-assisted therapy (methadone or suboxone for addiction), then the person is logically not yet at maximum medical improvement (MMI) and thus not ratable (yet). Referral for both substantiation of the diagnosis and

in AMA Guides® Newsletter
David J. Bourne

keloid formation on her forearms, which served to exacerbate her negative self-perception. She was perceived as flirtatious and often wore halter-tops and low-cut blouses to work, even in winter. The employee had a history of ongoing cocaine abuse and a past history of amphetamine addiction. She had a history of multiple failed relationships and impulsive behavior, but was socially engaging. She was perceived by others as a fun person when things were going well, but was quick to react with rage and feel abandoned. At such times, she contemplated suicide, and had a

in AMA Guides® Newsletter
Tim Pinsky

generally do not want to participate in an IME. They may be contentious and disagreeable, particularly in the context of litigation. Extensive scientific findings have indicated that eligibility for compensation is the most dominant factor for chronic pain claims. 7 There is a high prevalence of psychopathology in examinees that ranges from mild, such as an adjustment disorder, to severe, such as personality disorders and drug addiction. Second to compensation, personality disorders have been identified as a significant risk factor. 8 , 9 , 10 , 11 Because an IME is

in AMA Guides® Newsletter
Steven D. Feinberg

-based medicine causation principles. Document Pre-Existing Disability When doing evaluations for California SIBTF cases, documenting the injury and disability history that predated the industrial injury is of critical importance. Medical records coupled with the patient's recollected medical history are important and need to be reviewed carefully. Items in the review should include the past medical history, addictions to drugs or alcohol, obesity, sleep apnea, tobacco usage, medication usage, asthma, neurocognitive disorder, diabetes, heart disease, hypertension

in AMA Guides® Newsletter
Restricted access
James B. Talmage
and
Robert B. Snyder

opioids on analgesia, overdose, and addiction. 2 In 2011, the American Medical Association (AMA) Guides ® Newsletter published an article entitled, “Prescription Narcotics: An Obstacle to Maximum Medical Improvement.” 3 Based on literature published before 2011, this article showed that in some individuals, chronic opioid therapy created opioid-induced hyperalgesia (OIH), meaning the drug caused pain to be perceived as more painful than it was before opioids were started. Barth cited an epidemiologic study 4 that focused on Danish patients with noncancer pain

in AMA Guides® Newsletter
Richard T. Katz
and
Robert B. Katz

the lifespan . JAMA Psychiatry. 2016 ; 73 : 575 – 581 . 55. Liskow BI , Powell BJ , Penick E , et al . Mortality in male alcoholics after 10-14 years . J Stud Alcohol. 2000 ; 61 : 853 – 861 . 56. Hser Y , Kagihara J , Huang D , et al . Mortality among substance-using mothers in California: a 10-year prospective study . Addiction. 2011 . doi: 10.1111/j.1360-0443.2011.03613.x . 57. Torralba L , Brugal MT , Villalbi JR . Mortality due to acute adverse drug reactions: opiates and cocaine in Barcelona . Addiction. 1996

in AMA Guides® Newsletter
Robert J. Barth

Others signs of preoccupation with general medical health A tendency for treatment to produce brief improvements that are not maintained Tranquilizer use Development of narcotic addiction Development of drug-induced confusional states Unsuccessful surgeries A history of excessive general medical investigations Inability to stay in regular employment The pain enables the individual to avoid some activity The pain allows the patient to obtain some form of support that is otherwise not forthcoming Dissociative symptoms Pain recurring at the site of a

in AMA Guides® Newsletter
Marcos Iglesias

): Claim duration by 76% Total incurred costs by 341% Temporary total disability (TTD) days by 285% Litigation rates by 147% Surgery rates by 123% FIGURE 6 Effect of Multiple Comorbidities 34 The researchers found that multiple comorbidities and obesity had similar effects on outcomes. Mental health and addiction-related conditions had a disproportionate effect on litigation rates and disability duration. Interestingly, tobacco use did not have a significant impact on the outcomes measured. Why Do Comorbid Conditions Lead to Poorer Outcomes

in AMA Guides® Newsletter