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Opioid Dependence Linked to Poorer Post-Rehab Outcomes

Patients in program meeting criteria for postinjury dependence less likely to return to work

MONDAY, Sept. 29 (HealthDay News) -- Prescription opioid dependence was found to be relatively common in patients with chronic disabling occupational spinal disorders beginning a functional rehabilitation program, according to research published in the Sept. 15 issue of Spine.

Jeffrey Dersh, Ph.D., of the PRIDE Research Foundation in Dallas, and colleagues assessed the outcomes of 1,323 patients with these spinal disorders who entered a restoration program at a regional referral center. All had partial or total work disability for at least four months and severe functional limitations.

The investigators found that 15 percent of the patients met criteria for postinjury prescription opioid-dependence disorder (ODD) upon entering the program. After adjustment for relevant factors, these patients were 1.7 times less likely to return to work after completing the program, 2.0 times less likely to be employed at the one-year follow-up and 1.7 times more likely to seek health care from a new provider, with significantly more visits, the researchers report.

"In light of these findings, clinicians who prescribe opioids should become familiar with preinjury risk factors for ODD and behaviors indicative of high risk of problematic opioid use. The use of screening instruments to identify those at high risk for opioid dependence may be considered as part of standard clinical care. Once risk factors or problematic behaviors are identified in a particular patient, effective management procedures can balance the dual goals of analgesia and avoidance of iatrogenic ODD," the authors write. "Explicit limit setting, in the form of opioid agreements, have been found to be effective in these circumstances."

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