Long-Term Opioid Prescription Therapy

If you have been prescribed opioids for pain for a long period of time, the Office of Workers’ Compensation Programs (OWCP) Division of Federal Employees’ Compensation has recently instituted a program of greater control on the prescribing and utilization of opioids. The OWCP’s initiative entails careful review, regular periodic monitoring and to greatly increase their scrutiny of opioid usefulness.

Their goal is to work with the prescribing physician to provide safe effective care that is supported by informed clinical decision-making and improved communication with the patient/claimant. The prescribing health care provider is being strongly urged by the OWCP to review the opioid prescribing guidelines set forth by the Centers for Disease Control and Prevention (CDC). These guidelines have been attached to the OWCP letter sent to the prescribing physician.

Specifically, the CDC recommends that opioids should only be used when the benefits are likely to outweigh the risks. For acute pain, prescriptions should only be for the expected duration of pain and severe enough to need opioids, which is often three days or less and rarely more than seven days. For chronic pain, opioids should not be considered a first-line or routine therapy. Non-pharmacologic therapy and non-opioid pharmacologic therapy is preferred.

The OWCP is requesting that the physician prescribing long-term opioid therapy to provide established treatment goals that include realistic goals for pain and function and consider how opioid therapy will be discontinued if benefits do not outweigh risks. Following CDC Guidelines, the OWCP expects that continued opioid therapy will only be authorized if the physician establishes that there is a clinically meaningful improvement in pain and function that outweighs the risks to patient safety.

In prescribing opioids, the OWCP is requesting the attending physician of record ensure that the lowest possible dose at the shortest duration is being used and that extended release of long-acting opioids are avoided. Benzodiazepines, Sedatives, and Carisoprodol are avoided. That risk factors for opioid related harms are addressed, pertinent state Prescription Drug Monitoring Program (PDMP) data is reviewed and that the claimant is aware of possible opioid dependence and addiction.

The prescribing physician is reminded by the CDC, as supported by the OWCP, to use immediate-release opioids when starting instead of extended-release/long-acting (ER/LA) opioids. Start with the lowest effective dosage. Not to prescribe ER/LA opioids for acute pain. If opioids are needed for acute pain, prescribe no more than needed. Follow-up and re-evaluate risk or harm. The physician should evaluate benefits and harms with the claimant within 1 to 4 weeks of starting opioid therapy for chronic pain or dose escalation. Three days or less will often be sufficient; more than seven days will rarely be needed. The physician should evaluate benefits and harms of continued therapy with the claimant every 3 months or more frequently. If benefits do not outweigh harms of continued opioid therapy, physicians should optimize other therapies and work with the claimant to taper opioids to lower dosages or to taper and discontinue opioids.

In addition, the physician should on a regular basis evaluate risk factors for opioid-related harms. Check PDMP for high-dosages and prescriptions from other providers. Use urine drug testing to identify prescribed substances and undisclosed use. Avoid concurrent benzodiazepine and opioid prescribing and arrange treatment for opioid use disorder if needed. When your Morphine Equivalent Dose (MED) is at or above 90, it is of concern and considered potentially unsafe based upon guidance issued by the CDC as utilized by the OWCP. So, if your opioid dose is above that level the OWCP will no longer automatically authorize it.

Learn more at www.cdc.gov/drugoverdose/prescribing/guideline.html.

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