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Addiction Issues and Narcotic Tapering in Chronic Pain Patients

Posted by Fernando Branco on April 25, 2017 at 11:03 AM

On this week’s episode, we will hear from Dr. Fernando Branco. He is the medical director at Midwest Employers Casualty Company, where he leads a team of medical professionals who work with claims administrators to improve medical care and control losses in entities. He will introduce us to the ways in which chronic pain can be treated, how to find the best physician to treat addiction issues, and how to define if your workers need inpatient and/or outpatient treatment.

Dr. Branco has been practicing pain and medical rehabilitation for over 30 years. He explains how a combination of factors created the current narcotic epidemic we see in the United States.


90% of all narcotics used in the world are in the United States with only 3-4% of the world’s population.


What is Chronic Pain?

  • Acute pain – First two weeks of pain.
  • Subacute pain - Up to 3 months of pain in a targeted area.
  • Chronic Pain - 3 or more months of pain in a targeted area. If the patient has some sort of surgery or trauma, then narcotics would be recommended to help with pain management. The downside of narcotics is that after three months of use they start to create a variety of side effects.

As a general rule, depending on each patient and their needs, narcotics is no longer the first option to treat chronic pain.

Red Flags of Worker/Patient Chronic Pain Prescription Abuse

  • Requesting very specific types of drugs
  • Increased dosage without a prescription
  • Declining of other treatment options, such as physical therapy
  • Selling prescribed pills
  • Constantly ‘losing’ prescriptions
  • Diminishing of social and/or work skills  
  • Failing or refusing to do drug screens 

Addiction vs. Physical Dependency

Addiction includes both a psychological and physical dependency component. One aspect of physical dependency involves becoming so tolerant of the current dosage that the body begins to require higher and higher doses to receive the same relief. 

Drug Testing

It is suggested to administer regular urine tests to patients/workers who are on narcotic pain relievers. Also, If there are inconsistencies regarding drug analysis in the lab, tests should be administered more often to protect not only the physicians, but the patient as well. 

If your entity is administering drug tests, ensure that you have a good chain of custody system and procedures in place to test the quality of the urine. For instance, safeguards should be in place to make certain that the sample hasn't been diluted with water and records of the urine test should be kept on file before the patient commences their chronic pain relief prescription. 

PDMP - Prescription Drug Monitoring Program 

All pharmacies will input a specific patient's information into the system. The prescribing doctor can access the patient's information on the database and see if the patient is receiving medications from other doctors. Most states have some form of this program, but the only downside is that their is no enforcement to encourage all doctors to implement it. Kentucky, Virginia and Tennessee have an agreement to share their information to prevent individuals from traveling to different states to acquire prescription drugs.