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OPIATES/OPIOIDS

"An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract. The receptors in these organ systems mediate both the beneficial effects and the side effects of opioids....Opioids are among the world's oldest known drugs; the use of the opium poppy for its therapeutic benefits predates recorded history. The analgesic (painkiller) effects of opioids are due to decreased perception of pain, decreased reaction to pain as well as increased pain tolerance. The side effects of opioids include sedation, respiratory depression, constipation, and a strong sense of euphoria. Opioids can cause cough suppression, which can be both an indication for opioid administration or an unintended side effect. Opioid dependence can develop with ongoing administration, leading to a withdrawal syndrome with abrupt discontinuation. Opioids are well known for their ability to produce a feeling of euphoria, motivating some to recreationally use opioids.

Although the term opiate is often used as a synonym for opioid, the term opiate is properly limited to the natural alkaloids found in the resin of the opium poppy (Papaver somniferum). In some definitions, the semi-synthetic substances that are directly derived from the opium poppy are considered to be opiates as well, while in other classification systems these substances are simply referred to as semi-synthetic opioids." Wikipedia

To control abuse and expense, the DWC issued special guidelines for pain treatment and opioid use, effective July 28, 2016.

Label Item Links Comments
Websites National Institute on Drug Abuse Opioids: Abuse & Addiction  
  MTUS guidelines for pain treatment and opioid use, effective July 28, 2016. MTUS guidelines for pain treatment and opioid use  
  Opiate Pain Relievers for Chronic Pain Chronic Pain   
  FDA: Risk Evaluation and Mitigation Strategy (REMS) for Extended-Release and Long-Acting Opioids FDA   
Commission on Health and Safety and Workers' Compensation (CHSWC) CHSWC This agency is currently studying opioid-prescribing practices and considering guidelines: see press release
Practice Tips There is widespread concern about the extended use of opioid pain pills and patches in workers' compensation cases. Clients should be alerted to the impending crackdown and be prepared to discuss with their doctors a switch to non-narcotic medications, detoxification, and functional restoration programs.    
Articles

Opioids in Workers' Compensation (Feinberg): handout from DWC 20th annual educational conference 2/13

Opiates, Up Close and Personal by Robert G. Rassp, Esq.

DWC Opioids

 

Rassp on Fentanyl

Magazine Articles Opioids and Chronic Pain Treatment by Steven D. Feinberg, M.D.

The Faces Behind Narcotics: A Nurse Case Manager’s Perspective by Sue Bowers, RN-BC, BSN, CCM
Feinberg on opioids


Bowers on opiates

 
Roundtable Acupuncture and Opiate Use: Frances E. Kalfus, O.M.D., L.Ac. Acupuncture & Opiates  
Miscellaneous Confessions of an English Opium-Eater by Thomas De Quincey Confessions - De Quincey  "The opium-eater loses none of his moral sensibilities or aspirations.  He wishes and longs as earnestly as ever to realize what he believes possible, and feels to be exacted by duty; but his intellectual apprehension of what is possible infinitely outruns his power, not of execution only, but even of power to attempt."

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