The national opioid epidemic has prompted regulators, government agencies and, of course, the workers’ compensation industry to implement actions designed to address the problem. While these efforts are commendable, it’s important we take an educated approach to these drugs.
The workers’ compensation industry has made good strides toward stemming the complications associated with opioids. But lost in the conversation is a clear cut discussion of who, how and why opioids affect certain people. A blanket opposition to opioid use can be counterproductive.
The best way to truly prevent the potential negative consequences of opioid use is to act from a position of knowledge.
Effects of Opioids
A first time user can die from the effects of opioids. Everyone who uses them will soon become physically dependent on them. However, not everyone will become tolerant of the drugs, and even fewer will become addicted. It’s impossible to precisely pinpoint who is most vulnerable to addiction or when that shift will occur. But there’s quite a bit we do know that can help us as we make decisions.
Dependence. Many substances produce physical dependence without addiction. Caffeine and SSRIs — a class of antidepressant drugs are two examples. Injured workers with a physical dependence on opioids need the drug in order to feel normal; they experience withdrawal or abstinence syndrome if they abruptly stop taking the medication. Withdrawal symptoms may include anxiety, tremors, body aches, gastrointestinal issues, runny nose, sweating, and increased heart rate and blood pressure.
Tolerance. A patient who develops tolerance to opioids needs increased dosages to get the same effect, or feels a diminished effect from continuing the same dose.
Addiction. Addiction affects an estimated 2 – 5 percent of those on opioids; however, it is the most dangerous effect from opioids and left untreated can ruin and even end lives. It is related to physical dependence but different.
Brain sites of addiction differ from the brain sites that mediate physical dependence. Opioids affect the brain’s reward/pleasure center. Addiction occurs when the drugs lead to cravings that go beyond pain relief. It may be subtle. When addicted, injured workers don’t use their drugs the way the doctor prescribes.
Some worrisome signs of potential addiction include running out of medication early, getting opioids from different doctors and lying about losing a prescription. Some people even turn to street drugs such as heroin to satisfy their cravings. An injured worker with a history of substance abuse who develops a painful condition should consult an addiction specialist.
Some injured workers on opioids may actually have other conditions that are incorrectly labeled addiction. Pseudo addicts, for example, typically have a pattern of drug seeking behavior similar to addicts because they are receiving inadequate pain management. This can be resolved with appropriate pain reduction medications, such as ibuprofen or acetaminophen.
Injured workers may also use opioids inappropriately to manage stress, a condition called chemical coping. Finally, there are injured workers who need to increase their dosages not due to tolerance, but because of factors such as disease progression, new disease, increased physical activity, lack of compliance, change in medication, drug interaction, and deviant behavior.
Appropriate Opioid use
Opioids are ideal for helping terminally ill patients who are in pain. For injured workers, the drugs can relieve severe pain after an injury or surgery, but should be used only for the short term. Research has shown that opioids should not be used as the first line of treatment for chronic pain.
Among the complications that can develop from opioid use is hyperalgesia, in which the brain interprets normal sensations as painful. Extended use of opioids can actually become a source of increased pain. The injured worker will feel better and have less pain only after being weaned off the opioids.
One of the most dangerous uses of opioids is in combination with other medications, especially benzodiazepines, such as Xanax and valium. Taking them together increases the risk of overdose as they can increase the likelihood of respiratory depression.
Opioids can be a lifesaver for people in excruciating pain, but should be used only for a short time or after all other treatments have failed. Using them for an indefinite period changes the way the brain and nervous system interact and raises the risks the injured worker will become susceptible to the negative consequences of the drugs.
High risk injured workers and those with chronic pain should be treated with alternative methods, such as cognitive behavioral therapy. CBT and other strategies teach the injured worker to soothe himself and greatly reduce his pain, allowing him to return to functionality and work.
Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.
For additional information, contact us at https://theimcsgroup.com, or http://www.cope-with-pain.com. Please join our LinkedIn group, COPE with Pain at https://www.linkedin.com/groups/8540640
Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.