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Showing posts with label Addiction. Show all posts
Showing posts with label Addiction. Show all posts

Wednesday, May 1, 2019

Federal opioid limitations: Good intentions, bad outcomes

Today's guest author is Jon Rehm, Esq. of the Nebraska bar.

Senate Republicans and Democrats, including Presidential candidate Kirsten Gillibrand, have introduced legislation that would limit opioid prescriptions to a set number of days and limit refills. In my view such legislation would negatively impact people who were injured on the job.

I mostly agree with analysis of the legislation that was recently published in Rewire. One size fits all solutions don’t account for the needs of patients with chronic pain. Recently authors of the Centers for Disease Control guidelines for opioid prescriptions have stated that those guidelines have been misused to arbitrarily limit opioid prescriptions for pain management.

As a practical matter, in my experience prescriptions for opioids are already severely limited for injured workers. Statutory limits on opioids are a good excuse for insurers and self-insureds to wash their hands of future medical care obligations under workers compensation.

Opioid prescription limitations have other effects. Pain doctors who don’t prescribe opioids have more time to perform procedures. Procedures are more profitable for doctors and increase cost. Primary care doctors are often reluctant to prescribe opioids which puts more pressure on pain management doctors. 

There are alternatives to opioids for pain management. Stem cell therapy has shown promise in treating pain. But insurers are reluctant to approve those options as that could increase costs for them and leave medical claims under workers’ compensation open.

I believe that opioid prescription monitoring is a better solution to fighting addiction than prescription limits. Those systems can flag potential problem users and get them help. In the case of someone hurt on the job who develops an addiction to pain medication, treatment for that addiction could be covered by workers compensation.

Massachusetts also developed what amounts to a drug court for opioids within their workers’ compensation court. Problem solving courts, like drug courts, are being increasingly used to help those with substance use issues in the criminal justice system. Massachusetts has adopted the idea in an administrative setting. Federal limits on opioid prescriptions would run counter to innovative programs put in place at a state and local level.

Workers compensation laws developed in the early 20th century when workplace safety laws could only be constitutionally enacted through state police powers under the 10th Amendment. Constitutional law evolved changed during the New Deal era which gave Congress broader regulatory powers over workplace safety and the economy in general.

As a result of the broadening of federal regulatory powers, federal laws limiting opioid prescriptions would likely be constitutional even if they interfered with innovative state programs like Massachusetts workers’ compensation opioid court. While the federal government seems to feel compelled to undercut state workers compensation laws to the detriment of workers, the federal government has given up on oversight of state workers compensation laws that could benefit workers.

The United States Department of Labor monitored state workers compensation laws as result of recommendations from the National Commission on State Workers Compensation Laws.The Commission set up 18 standards for state laws. The DOL stopped overseeing state workers compensation laws in 2004.

In 2015 several Senators and Congressional members, including then and current Presidential candidate, Vermont Senator Bernie Sanders, wrote to the Secretary of Labor about reinstating federal oversight of state workers compensation laws. Reporting by Pro Publica highlighted the shortcomings of state workers’ compensation laws The Department of Labor has made no progress on federal oversight of state workers’ compensation laws since then.

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Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  has been representing injured workers and their families who have suffered occupational accidents and illnesses.


Sunday, October 20, 2013

Naloxone Expansion In California Will Enable Family, Friends To Save Lives At Home

Today's post was shared by Huffington Post and comes from www.huffingtonpost.com

Family and friends of more drug users in California will soon be able to reverse overdoses at home with a lifesaving injectable drug.
On Thursday, Gov. Jerry Brown signed into law Assembly Bill 635, authored by Assemblymember Tom Ammiano, which will expand the use of the drug naloxone. Naloxone, also known by its brand name Narcan, can be administered to a person suffering from an opiate overdose to restore breathing.
Naloxone is non-addictive, non-toxic, fairly cheap and is easy to administer through the nose or intravenously. It was approved by the Food and Drug Administration in 1971 and is stocked in thousands of emergency rooms, ambulances and post-surgery recovery rooms across the country. But frequently, opiate users don't make it to the hospital in time.
For that reason, in 2008, California implemented a pilot program in seven counties that allowed drug users, their family and friends, health care professionals and addiction counselors to administer naloxone in an emergency -- and be protected from civil or criminal liability if anything goes wrong.
The bill that Brown signed into law extends the program across all of California.
Starting Jan. 1, drug users and their family and friends will be able to request a naloxone prescription from a doctor or addiction treatment program.
For example, "if a teen is known to be picking up OxyContin, their family might -- in the treatment process -- want a naloxone prescription, just in case," Ammiano's communications director Carlos...
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