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Many injured workers turn to opioid painkillers for relief, and nearly 30 percent may still be taking them three months after their injury — increasing the odds of addiction, a new study suggests. “The increased likelihood of persistent opioid use among strain and sprain injuries is potentially concerning, particularly given the limited evidence to support opioid therapy for these injuries,” said study lead author Nathan O’Hara. He’s a research associate at the University of Maryland School of Medicine’s department of orthopedics, in Baltimore.
Common injuries for which people claiming workers’ compensation received opioids include crushes, strains and sprains, permanent disability and chronic joint pain, the researchers reported. Because many workers use opioids for work-related injuries, and given the danger of addiction, O’Hara believes it’s a big and possibly growing problem. Common opioids include OxyContin and Vicodin.
“Since persistent opioid use does not correlate well with injury severity, consideration should be given to not initiating opioid use for non-severe injuries,” he said. The main concern shared by doctors is the use of opioids for non-acute pain, said senior researcher Dr. Gerard Slobogean, an assistant professor of orthopedics at the University of Maryland School of Medicine. “Physical therapy, other complementary and alternative therapies, as well as non-opioid medical therapies, should be considered for many injured workers,” he said.
For the study, the researchers collected data on nearly 9,600 injured workers who filed workers’ compensation claims in Maryland from 2008 to 2016. All patients were initially treated with opioids. Other factors linked to persistent opioid use included being older and having a yearly income of more than $60,000, the researchers found.
Lindsey Vuolo is associate director for health law and policy at the Center on Addiction. “The high rate of persistent opioid use among injured workers in this study is concerning because such use may signify misuse, a risk factor for opioid use disorder,” she said. The progression from misuse to use of illicit opioids, such as heroin and fentanyl, is a hallmark of America’s opioid crisis, said Vuolo, who was not part of the study. In 2016, more than 11.5 million Americans reported misuse of prescription opioids, with more than 14,000 people dying from overdoses involving prescription opioids, the researchers noted.
What’s more, opioids are often ineffective for long-term pain management, Vuolo said. Safer treatment options, such as non-opioid painkillers and physical therapy, should be tried first to manage chronic pain, she said. Dr. Jianguo Cheng, director of the multidisciplinary pain medicine fellowship program at the Cleveland Clinic and president of the American Academy of Pain Medicine, agreed.
Doctors need to get out of the habit of prescribing opioids as the first option to treat pain, said Cheng, who was not involved with the study. “Minimize exposure and use in terms of dose and frequency,” he recommended. “However, for certain patients who have failed other treatments, opioids are still an option and can be effective. So patients should not be denied this treatment option.”