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Disability experts question long-term opioid use

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Managers of absence and disability benefits programs should look twice when health care providers prescribe morphine or other opioids for the relief of chronic pain.

Analysts at Reed Group Ltd. give that advice in the new opioid treatment guidelines included in their new Reed Group Disability Guidelines reference work.

Reed Group, a unit of Guardian Life Insurance Company of America, creates the guidelines to help benefits managers, health care providers and others understand treatment options that may affect the ability of sick or injured workers to return to work.

Reed commissioned independent experts at the American College of Occupational and Environmental Medicine to develop the new guidelines.

News organizations sometimes run articles featuring pain relief physicians who complain about the difficulties cancer patients and other patients have with getting access to what the physicians say are much needed opioid drugs.

The experts who created the new Reed guidelines say opioids can be helpful with relieving acute pain but are not necessarily any more effective than other, much safer medications at relieving chronic pain.

None of the 28 trials comparing opioids with other painkillers showed that opioids were clearly superior to other painkillers at treating chronic pain, and the longest trial that featured a control group taking a placebo lasted just fourth months, Reed analysts say.

About 80 percent to 94 percent of trials of long-term opioid use involve opioid industry funding or other actual or potential conflicts of interest, the analysts say.

When a health plan or other benefit plan allows use of opioids for treatment of chronic pain, the plan should consider limiting the allowed dose to the equivalent of 50 milligrams of morphine, the analysts say.

In the past, the analysts say, some providers prescribed doses of 100 milligrams to 120 milligrams, and that higher limit seems to have increased the risk of patients dying, the analysts say.

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