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Optum Workers’ Comp and Auto No-fault clinical programs align with updated guidelines for chronic pain

September 10, 2020 · Optum Workers' Comp and Auto No-fault

ODG has been making changes to treatment guidelines. Optum is following suit by changing some of our program parameters. Beginning September 23, 2020, Optum is lowering our opioid alerting parameter to 90 mg of oral morphine equivalents (morphine equivalent dose, or MED) for treating chronic pain. This change aligns with the ODG opioid upper-limit recommendation, which was recently changed to 90 mg MED, down from 100 mg MED, and now coincides with the recommendation of the Centers for Disease Control and Prevention (CDC). In 2016, the CDC published guidelines for prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. (For more on MED, refer to https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf)

Along with the decrease to an upper limit of 90 mg MED, the guidelines continue their recommendation of caution for an MED level of 50 mg per day and suggest opioid dosages should not exceed 90 mg MED in injured persons moving into more chronic treatment of pain. The MED threshold of 90 mg per day is also recommended for those who are currently taking high-dose chronic opioid therapy, with the understanding that careful tapering should be coordinated across the health care team, including the ongoing review of risk and benefits by the treating prescriber.

According to the CDC, when opioid analgesics are initiated, clinicians should prescribe the lowest effective dose. Clinicians should also use caution when prescribing opioids analgesics at any dosage, and exercise care to reassess evidence of individual benefits of the opioid treatment, all while evaluating escalated risks when increasing dosages. The guidelines emphasize avoiding a dose above 90 mg MED and that diligence and careful consideration be given if going above this dose with documented justification.

Impact on workers’ comp and auto no-fault

Nationally-recognized treatment guidelines, as well as state-based guidance, have changed over the last few years with regard to recommended MED limits and may differ depending on the source and state of jurisdiction. It is important to understand that MED limits may as well vary for the treatment of acute, subacute and chronic pain.

At Optum, our clinical programs have been modified to coincide with an upper limit of 90 mg MED per day in alignment with CDC and the updated ODG and will be effective on Wednesday, September 23, 2020.

If you have any questions, please contact your account manager, clinical liaison, or our Clinical Services team at 1-877-275-7674 ext. 8612.

Sources:
1.  Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain-United States, 2016.
     MMWR Recomm Rep 2016;65:1-49.
2.  CDC Guideline for Prescribing Opioids for Chronic Pain At-A-Glance.
     Available at: https://www.cdc.gov/drugoverdose/pdf/Guidelines_At-A-Glance-a.pdf.
3.  ODG by MCG Treatment Guidelines [database online]. An MCG Health Company. Accessed on August 19, 2020.
     https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf Accessed on September 3, 2020.

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