February 06, 2018 BY Charles Hoey
The Center for Disease Control (CDC) Initiate Additional Guidelines and Information
The Center for Disease Control (CDC) initiated additional guidelines and information regarding the proper use of opioids and to educate doctors and patients about the opioids epidemic. Our recent update about the new CDC guidelines for prescribing opioids can be viewed here:
The CDC has also issued a mobile app with their guidelines for prescribing opioids for chronic pain. It can be accessed here: https://www.cdc.gov/drugoverdose/prescribing/app.html
The app and CDC website have a morphine milligram equivalent (“MME”) calculator. This tool allows you to enter certain opioid medications, with the dosages of each medication, into the calculator, to determine the MME. The CDC strongly recommends that individuals be kept below 50 MME per day. Above 50, research shows that patients have little or no additional pain relief but a significant higher risk of overdose.
This calculator is not a tool for attorneys or claims adjusters to practice medicine without a license. The calculator is a useful tool but certainly does not contain “all the answers,” nor is the calculator a substitute for a medical license. Every case is different. It is a mistake to think of the practice of medicine as being like preparing a recipe where one simply has to follow the instructions in a cookbook. This tool will help you identify claimants who are taking high amounts of opioids. It is fair to ask doctors whether a patient needs to be weaned from the current opioid dosages based upon the CDC Guidelines. The answer will sometimes be “no,” but the question is legitimate. This calculator can also be used to help identify individuals who might need an IME or a change in physicians.
It should also be noted that this calculator is for the long term use of opioids to treat chronic pain. For individuals who have just suffered an acute injury for who are in hospice care suffering from severe pain, these guidelines do not apply.
The links also help you identify which medications have the greatest risk for addiction or overdose. The CDC has a table showing the conversion factor for various opioids. If you go to the table, you can see that an individual would have to take 10 tablets, every day, of hydrocodone/acetaminophen 5/300 to hit the MME level of 50. Methadone, Oxymorphone and fentanyl have high conversion factors.
Finally, the CDC website has information for patients which you can review by clicking here: https://www.cdc.gov/drugoverdose/patients/materials.html
We hope these brochures will be provided to patients who are prescribed opioids for chronic pain. Although medical decisions should not be made by employers and insurance carriers, patients should be able to make informed decisions. With these brochures, some patients may learn what questions they ought to ask.
When choosing physicians for your posted panels of physicians, we recommend selecting physicians who will provide this information and educate their patients about the risks of opioids. If you wish to send this information to claimants who are receiving opioids, be careful not to say too much or go outside your area of expertise. We would simply state that “this information from the Center For Disease Control (“CDC”) may be of interest to you; please direct any questions you have about your medications to your treating physician.”
We hope that you find this information useful. Please do not hesitate to contact us with questions or to schedule a seminar for more detailed training about opioids and insurance claims.
The Journal is a publication for the clients of Drew Eckl & Farnham, LLP. It is written in a general format and is not intended to be legal advice to any specific circumstance. Legal Opinions may vary when based upon subtle factual differences. All rights reserved.
H. Michael Bagley