Redefining Detox in Workers' Comp

When most people in workers’ compensation hear the term “detox” they think of chemical detox, the process of removing or reducing the prescription drugs patients are taking to deal with their pain. Indeed, injured workers on drug regimens with questionable clinical efficacy (low function, low quality of life) need to go through a process to lower the dosage and number of drugs they’re taking or eradicate them entirely. Chemical detox can be very complicated; a benzodiazepine like Valium or Xanax can take as long as 18 months to wean and should typically be the final drug weaned because of how this category of drugs complicates the medication regimen and causes side effects. Methodone or Suboxone might be added to help facilitate the weaning, but they come with their own issues -- significant clinical complications for Methodone and becoming a long-term maintenance drug for Suboxone. However, if you think of detox only as a chemical weaning process, you can miss the most important component in affecting permanent change: the psychosocial aspect. Removing dangerous drugs without any plan for addressing how claimants can physically and mentally cope with their pain can lead to relapse. Folks in the functional restoration field say that 75% of patients remain off 75% of their original drugs after 12 months if they are involved in a best-practices clinic. I’ve researched this issue over the past two years, visiting many detox and functional restoration programs. Functional restoration and detox facilities are not created equally, and not all physicians are knowledgeable or proficient in weaning. I am absolutely convinced that best practices involve an interdisciplinary treatment approach. If you do not have a team composed of a licensed MD/DO to manage the medical and addiction issues, a licensed physical therapist to increase function, flexibility and stamina and a licensed psychologist to address psychosocial issues, the injured worker won’t make all the behavioral and mental changes required to stay off inappropriate drugs. Work comp is deathly afraid of a psych-compensable diagnosis because it can open doors well beyond vocational, but we cannot ignore what happens in a patient’s conscious and subconscious mind. If you ignore the psychology behind addiction and dependency and neglect to address things like low self-esteem, catastrophizing and perceived injustice, the patient isn’t likely to truly and permanently change. Two to three months after being discharged as clean, the patient is likely to resume old habits of overusing or abusing prescription drugs. Relapse may also occur if the patient fails to learn non-pharmacological pain-coping skills like yoga, Pilates, stretching and other physical exercise. It is tempting to try to close a claim upon receipt of a clean discharge from a detox facility. After all, the drug regimen will look as good then as it ever will, and it would be naïve to think that isn’t a driver in some cases. But if the goal is to truly restore claimants to as close to pre-injury condition as possible for the long term, do your homework on those conducting the weaning and take into consideration the body-mind connection.