Western Occupational & Environmental Medical Association
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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 


Must-Have Resources for the OEM Practitioner

AMA Guides to the Evaluation of Permanent Impairment, Sixth edition.

ACOEM Occupational Medicine Practice Guidelines, Third Edition The first edition of the Guidelines was published in 1997, and subsequently updated in 2004. This four-volume third edition of the Guidelinesincludes a one year subscription to the on-line application, APG-I, to allow rapid access to the updated chapters. Click here for more information.

Disaster Preparedness and Awareness Guide for the Arizona Physician (published February 2008 by the Arizona Medical Association) – Click to Download

Occupational Safety and Health Administration (OSHA) – Spirometry Testing in Occupational Health Programs – Best Practices for Healthcare Professionals (PDF)