New studies and guidelines address two persistent Workers' Comp issues: opioids and obesity

Opioids

ACOEM tightens guidelines for the use of opioids in safety-sensitive jobs

Against the backdrop of exploding opioid use, the American College of Occupational and Environmental Medicine (ACOEM) determined that an update to the guidelines, which were last issued in 2009, was warranted. The new guidelines are significantly stronger and recommend against prescribing chronic or acute opioid use for employees in 'safety-sensitive' jobs.

These guidelines are considered 'evidence-based' i.e., developed by using the most reliable and current evidence to inform patient care decisions. The related research, ACOEM Practice Guidelines: Opioids and Safety Sensitive Work, undertaken by Kurt T. Hegmann et al, is summarized and published in the July 2014 edition of the Journal of Occupational & Environmental Medicine.

The conclusion that "[a]cute or chronic opioid use is not recommended for patients who perform safety-sensitive jobs" is supported by substantial evidence. Studies reviewed by ACOEM found an association between opioid use (whether weak or strong opioids) and an increased risk of motor vehicle crashes, with risk increases estimated from 29% to a startling 800%. ACOEM extrapolated these results to caution against chronic or acute opioid use in connection with any 'safety-sensitive' job, including operating heavy equipment, driving a forklift, working at heights, or working at tasks requiring high levels of cognitive function. ACOEM guidelines recommend that the patient wait until approximately 90% of the opioid has left his or her system before engaging in 'safety-sensitive' tasks.

While the new guidelines are a step in moderating opioid abuse, it is up to the physician community to follow the best practices of medicine instead of simply prescribing for profit. It reinforces the importance to employers of forming relationships with physicians who understand occupational medicine.

Opioids prescriptions highest in southern states

Opioid prescriptions per person nationwide are highest in southern states, including Alabama, Tennessee, and West Virginia, according to the U.S. Centers for Disease Control and Prevention (CDC) "Vital Signs" July report, which analyzed 2012 prescribing data collected from retail pharmacies by a commercial vendor. States with the least number of opioid prescriptions per person included Hawaii, California, New York, Minnesota and New Jersey.

Providers in Alabama, the highest prescribing state, wrote nearly three times as many prescriptions per person as prescribers in Hawaii, the lowest prescribing state. A total of 259 million prescriptions for opioid painkillers were written nationwide that year, the study said.

New York and Tennessee, which require prescribers to check drug-monitoring programs before prescribing opioids, saw a decrease in the number of patients who were seeing multiple providers to obtain drugs in 2012, according to the study. Meanwhile, Florida, which regulates pain clinics and physician dispensing, saw a 50% decrease in overdose deaths in 2012, the study said.

Opioid use before spine surgery lowers patient-reported outcomes

Opioids are commonly used for preoperative pain management in patients undergoing spine surgery. A new study appearing in the Journal of Bone and Joint Surgery (JBJS) links the use of opioid pain relievers (prescription medications, such as Percocet) to lower improvement and higher levels of dissatisfaction following spine surgery. While previous studies found a link between opioid use and less favorable spine surgery outcome, this study also examined the impact of the level of opioid use. Patients reported health status preoperatively, and at three and 12 months following surgery, using a range of established medical tests that measure levels of physical and mental function, depression, distress, back and other pain, disability, somatization (chronic, physical symptoms with no known cause) and treatment results. Among the findings:

• Increased preoperative opioid use was a significant predictor of worse health outcomes at 3 and 12 months following surgical treatment
• Every 10-milligram increase in the daily morphine equivalent amount taken preoperatively was associated with a decrease in mental and physical health and disability scores
• Opioid consumption seems to occur frequently in those with psychiatric comorbidities such as depression and anxiety, possibly leading to increased opioid use

Obesity

Obese workers tire more quickly

Based on results from a new study published in the Journal of Occupational and Environmental Hygiene (JOEH), workers who are obese may have significantly shorter endurance times when performing workplace tasks, compared with their non-obese counterparts. The study, conducted at Virginia Tech, examined the endurance of 32 individuals in four categories (non-obese young, obese young, non-obese older, and obese older) who completed three distinct tasks that involved a range of upper extremity demands - handgrip, intermittent shoulder elevation, and a simulated assembly operation. Each task involved periods of work and rest, and included pacing demands similar to those experienced by workers in manufacturing settings.

On average, approximately 40 percent shorter endurance times were found in the obese group, with the largest differences in the handgrip and simulated assembly tasks. Obesity is associated with physiological changes at the muscular level, including a decrease in blood flow, thereby limiting the supply of oxygen and energy sources. When performing sustained contractions, these physiological changes may lead to a faster onset of muscle fatigue.

The study notes, "Workers who are obese may need longer rest breaks to return to their initial state of muscle function. Based on the increased fatigue found among workers who are obese, workplace designers may need to consider adding fixtures and supports to minimize the amount of time that body mass segments need to be supported."

Extreme obesity cuts lifespan more than smoking

That obesity can cut life short by causing strokes and other illnesses comes as no surprise, but a study published in the journal, PLOS Medicine, found the most extreme cases cut a person's lifespan more than cigarettes.

The largest-ever study of the effect of extreme obesity on mortality, it found that people who are extremely obese - for someone of average height, carrying an extra 100 pounds or more - die 6.5 to 13.7 years earlier than peers with a healthy weight. Extreme obesity affects 6 percent of adults in the United States and is defined as having a body mass index of 40 to 59.9.