Monday, July 2, 2012

MMI and Narcotics: Can't Get There From Here

For those of you with access to the American Medical Association's "Guides Newsletter", check out the March/April 2011 issue.  There's a great article entitled Prescription Narcotics: An Obstacle to Maximum Medical Improvement.  (I'm actually not that behind in my reading... I was just given a copy of this particular article recently). 

The article points out that there are "concerns that the obstables to MMI created by prescription narcotics will delay the resolution of claims (which could be harmful to the patient, as well as to other stakeholders).  There is also concern that evaluators will confuse the effects of narcotics with permanent impairment and will consequently create erroneous impairment ratings."

The basic premise here is that narcotics expand the nature of a patient's impairment beyond pain.  When one is on narcotics for a long period of time, MMI becomes nearly impossible to assess with any degree of accuracy. 

We're starting to see some physicians justify chronic opioid therapy and refuse to respond to the evidence because "the patient is at MMI."

Challenge this presumption.  It will benefit you and your claimant when you do. 

On Twitter @PRIUM1


  1. Michael,
    Some of the issues we have is that the doctor's are declaring the patients MMI with the supportive care of continued opioid usage. The other problem we are facing is that not only does the cost increase but the opioid usage increase as well.

    On two occasions we have sent the claimant to another IME who has recommended a decrease in the opioid medications but the treating physician refuses to comply with the IME.

    Have you had any experience with this type of scenario? Do you have any recommendations?

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  3. I found a link to the article I referenced that you can access without a paid subscription. Dr. Barth addresses the challenged you outline. Hope it's helpful: