Canadian HR Reporter

CANADIAN HR REPORTER JUNE 2018 NEWS 7 Opioids linked to longer disability leaves Alternative pain management treatments should be considered: Experts BY SARAH DOBSON NEWS stories of late have been filled with alarming stories con- cerning opioid addiction and overdoses. Misuse of the prescrip- tion and non-prescription drugs has led to an epidemic in Canada and the United States. at's having an impact on em- ployers. In looking at the prescrip- tion of opioids to treat acute mus- culoskeletal disorders (MSDs), a Canadian review of five studies has found a link to longer dura- tion of time on disability. "ere's certainly an indication that there's a relationship between the two, that people who use opi- oids or higher doses of opioids tend to have prolonged work disability," said Nancy Carnide, a post-doctoral fellow at the Insti- tute for Work and Health (IWH) in Toronto, who led the review. "But (it's not clear) whether opioids are actually causing the work disability or whether it's something else… We're sort of saying there is no clear-cut causal relationship between opioids and workplace disability but, having said that, none of the studies have demonstrated that opioids pre- vent work disability or help in any way, and we know that there are significant risks of serious harm associated with opioids." "And RCTs (randomized control trials), in terms of pain and general function, really don't demonstrate that opioids are effective, so clini- cians should obviously continue to be cautious if they're ever going to provide opioids." e results are not surprising, according to Aaron ompson, medical director of occupational disease at the Workplace Safety and Insurance Board (WSIB). "When somebody's on opioids, because of the resulting impair- ment, it can become a principle barrier to return to work and we know a delayed return to work re- sults in ever-increasing disability duration, and the extent to which use of opioids delays return to work, that's going to worsen the prognosis for the worker and the outcomes are going to be worse." e IWH report is similar to previous research both from Mc- Master University and the WSIB, said Jason Busse co-director of the Michael G. DeGroote Centre for Medicinal Cannabis Research at McMaster University in Hamil- ton, which led a team that released guidelines in 2017 advising physi- cians to reduce their prescribing of opioid medication to patients with chronic non-cancer pain. "is is observational study, so we can't say it's a causal association, but certainly it's a very strong ob- servation from the kind of data that we do have to work with, and sug- gests that compensation boards such as WSIB may want to look very seriously at trying to reduce the number of patients that are prescribed opioids for their acute lower back pain complaints, and make available other types of mo- dalities and interventions," he said. When physicians are prescrib- ing these analgesics, they need to also have plan for deprescribing, said Busse. "It's easy to write that script but you need to have a plan for how you're going to help wean people off them as well. Because what we want to try to prevent in most cases is that initial acute prescription going on to become prolonged use." e IWH review raises ques- tions that are important for all the different stakeholders, said Marc White, president and CEO of the Work Wellness and Disability Pre- vention Institute in Vancouver. "It's really important for clini- cians to know the answer, but it's also important for workers' comp boards, human resources profes- sionals who are responsible for absence management, labour rep- resentatives, workers and other stakeholders that are concerned about prolonged work absence." Why the epidemic? Given their limited effectiveness, and definite risks, how did opioids come to be so popular? For one, pharmaceutical com- panies have aggressively marketed the substance and promoted it as being less addictive than mor- phine. At the same time, there was a push to manage pain more effectively, said Carnide. "It was just a culmination of this desire to manage pain and then we're hearing from pharmaceutical companies: 'Hey, we have this great product that will be effective and won't cause harm' ... unfortunately, that led to what we have now." North America uses 80 per cent of all opioids produced in the world, said Andrea Furlan, physi- cian and scientist at the IWH. "We know that opioids are the strongest painkillers that exist. ey're highly effective, anyone who has acute pain and needs some painkillers knows that you take the pill and the pain is prob- ably 100 per cent relieved," she said. "They are powerful, they are very effective, they're quick, they're cheap." But several years ago, there was a push to help people who suffer DIFFERENT > pg. 11 together Connecting people with the brands they love Venngo provides organizations the most comprehensive suite of private discount programs. We help people save money, save time and feel good. learn more www.venngo.com 1.866.383.6646 © Copyright 2018 Venngo Inc. All rights reserved. WorkPerks © is a registered trade-mark of Venngo Inc. All other trade-marks are the property of their respective owners. perks and/or discounts may not be as shown, and are subject to change without notice. V1_20180517

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