Death due to accidental overdosage from prescribed opiates,benzodiazepines and other mood altering drugs EXCEEDS the deaths from illicit HEROIN and COCAINE combined. Yet, we see injured workers ,and other patients, on high doses of multiple S8 and S4 drugs with benzodiazepines, Lyrica and mood altering drugs for non-malignant and non-septic back and neck pain with no radiculopathy or progressive spondylolisthesis. This is an often dangerous and at times fatal cocktail. The patient may consume some alcohol or take an extra dose of S8 opioid and go to sleep and have a respiratory arrest and die. Lyrica is a gabapentinoid and in doses> 300mg along with an S8 opioid is a respiratory depressant. The anaesthetic literature has published on gabapentinoids( >300 mg Lyrica or variant) pre-anaesthetic affecting post-anaesthesia respiration.
Addiction, dependence, habituation, respiratory arrest, secondary hyperalgesia, permanent sphincter dysfunction , depression and death etc are all associated with opiate use.
Inappropriate prescribing and horrors of dependence,addiction,withdrawal and accidental O/D and deaths continue .
These practices in injured workers ,with or without surgery/ies is left to the GP. This is also of concern . The surgeon must take charge and not leave these high risk drugs to the GP. GPs should consult Drugs of Dependence Consultants and Pain Management Specialists and also follow Medical Board and State Health Department Guidelines IMPLICITLY.
There are clear published guidelines on the use of opioids for chronic non-malignant pain in each State in Australia. Medical practitioners would be well advised to be familiar with these and use recommended pain management plans and trials with defined goals and reviews and not escalate doses without a plan.
Now, there are US legal decisions.In Queensland the issue of opioid use has been raised.In the US an opioid epidemic emergency was recently declared. We have regular warnings and comments by Coroners. These are sadly often too late.
Patients and IMEs are advised to follow the advice of their treating medical practitioner / indemnity insurer at all times.The opinions stated herein are solely those of the author with citations available.
Dr Michael Coroneos is a senior Brisbane neurosurgeon with six surgical Fellowships and was honoured to be elevated to Master CIME status by the American Board of Independent Medical Examiners (by 3 examinations and training 2012 to 2017) in May 2017.