Western Carolina RIMS presentation summary June 2018 Meeting The - PDF document

Teresa Bartlett, MD Senior Vice President and Senior Medical Officer Sedgwick Western Carolina RIMS presentation summary June 2018 Meeting The Opioid Epidemic a Perilous Drug Crisis How did we get here? • Purdue Pharma • Congress passed law late 2000 decade of pain control • Addictive properties not well understood • How opioids impact the brain Mu receptors Statistics from the CDC • 115 people die each day • Economic burden estimated at $78 Billion • Reduced male workforce by 20% • Added over 92,000 children to foster care system • Those addicted to prescription opioids are 40% more likely to become addicted to heroin • Long term use statistics o 1 day = 6.0% on opioids 1 year o >8 days = 13.5% on opioids 1 year o >31 days = 29.9% on opioids 1 year o 90 days = 60% 5 years later Kratom Carfentanil States respond to opioid crisis • 11 states have adopted formularies and many more to come • 29 states have passed limits on the first fill of an opioid • Some states require physicians to check the PDMP before prescribing an opioid • CARA Act has been adopted to allow partial fill of schedule II medications such as opioids Beware of dangerous drug combinations

• Importance of knowing all medications a person is taking BEERS criteria for those age 65 and older who have difficulty metabolizing medication Lock all medications in a lock box even those medications you think are not dangerous Opioid induced constipation Understand the impact of the BioPsychoSocial model in workers ’ compensation Adverse Childhood Events and all the research points to the potential for delayed recovery and addiction issues We must change our emphasis to focus on pre-injury and pre-pain and find alternatives to opioids Alternatives include • Stress management • Deep breathing techniques • Yoga • Acupuncture • Chiropractic • Pet therapy • Mindfulness Marijuana is now recreationally legal in 9 states • Medical marijuana is legal in 29 states and that number is growing by the day • Not a good replacement for opioids o Side effects: ▪ Anxiety ▪ Hypertension ▪ Many people present to Emergency rooms with symptoms of heart attacks ▪ Not federally legal “We know of no other medication routinely used for a non -fatal condition that KILLS patients so frequently” Dr. Tom Frieden, Former Director of the CDC