Author Affiliations: Departments of Psychiatry & Behavioral Sciences (Dr Sullivan) and Anesthesiology and Pain Medicine (Dr Ballantyne), University of Washington, Seattle.
In his letter, Dr Geller argues that employment protects against the risk of long-term opioid therapy and that the use of this therapy should be restricted to those patients who are “objectively working full time.”
We know of no studies that have examined the effects of long-term opioid treatment in employed samples. It is true that employed individuals have maintained a minimum of function despite chronic pain. They may have more flexible or less physically demanding employment, or they may have more rewarding jobs. Any rewards associated with continued function will tend to counteract any functional impairment associated with long-term opioid therapy. One recent study suggested that age and unemployment predicted opioid misuse in a small, mixed sample.1
Sullivan M, Ballantyne J. Clinician Identification of Appropriate Long-term Opioid Therapy Candidacy—Reply. Arch Intern Med. 2012;172(14):1110–1114. doi:10.1001/archinternmed.2012.2565
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