Western Occupational & Environmental Medical Association

Chronic Opioid Use: Comparison of Current Guidelines

Recent controversies about opioid misuse, including misuse among patients with chronic pain treated under Workers' Compensation have triggered calls for more stringent opioid prescribing guidelines. In particular, over the last decade in the United States, opioid overdoses, both fatal and non-fatal, have increased significantly, and most occur as a result of legal prescriptions, rather than illicit drug use. Indeed, although this epidemic of opioid overdoses has many causes, its epidemiology is still unclear, and may involve small numbers of physicians rather than the physician community as a whole, and may further be related to only a subset of opioid medications, such as sustained release oxycodone and a few others.

In August 2011, WOEMA compared and summarized seven sets of current opioid guidelines, and has noted some important differences among them, reflecting ongoing uncertainties and controversies in the treatment of chronic pain with opioids.* This summary is not meant to supplant or to preferentially weight any of the current guidelines, although we would note that the ACOEM Guidelines and the Medical Treatment Utilization Schedule appear to be among the best documented with clinical evidence, while other guidelines typically rely on consensus or Delphi methods.

In comparing these guidelines, we focused on nine basic questions, which we believe the clinician should consider when prescribing opioids for chronic pain, and have listed examples of specific answers as provided in these guidelines. [Download PDF] [Download Comparision Poster/Grid]

* Prepared by the WOEMA Legislative Affairs Committee Task Force on Opioid Use, August 15, 2011 

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Must-Have Resources for the OEM Practitioner

--WOEMA members receive discount pricing--

AMA Guides to the Evaluation of Permanent Impairment, Sixth edition.
Special price for WOEMA members: $132 (AMA list price $189; you save $57!)

Stay in compliance with code changes with AMA's official coding resource...
CPT 2009 Standard Edition: The Official Coding Resource for Procedural Codes, Rules, Guidelines and a recorded webinar titled: "Coding and Classification in the Occupational Medicine Office."With your purchase of this exclusive combo coding package, you will receive CPT 2009 and a link to the webinar recording to download the handouts and CME form. CME credit available: 1.5 AMA PRA category 1 credit and MOC EPIQ credit. Special Price for WOEMA members: $105 (You save $59.95 over the AMA price of the book plus the price of the Webinar)

AMA Guides order form (downloadable PDF)
CPT 2009 order form (downloadable PDF)

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ACOEM Occupational Medicine Practice Guidelines 2nd Edition 2008 Revision and the updated Elbow, Low Back, and Chronic Pain Chapters. Special price for WOEMA members: $199 Guidelines, $119 for updated chapters (You save $90 compared to non-member price)

ACOEM Guidelines order form (downloadable PDF)

For the discounted pricing, download the PDF order form and fax to: 847/818-9266