Tobacco’s Impact on Medical Treatment and Healing in Workers’ Compensation

Author: Cameron Hannum, Pharm.D., Sr. Clinical Account Pharmacist, Enlyte

Tobacco use and smoking has wide-ranging implications for health and overall individual wellbeing, including the ability to negatively impact medical treatment outcomes and wound healing processes. In the context of workers’ compensation, where injured employees undergo medical treatment and rehabilitation, understanding the impact of tobacco use is of particular importance.

Effects of Tobacco on Wound and Bone Healing

Tobacco use has been shown to significantly impair the wound healing process. Even smoking one cigarette reduces the body’s ability to provide necessary nutrients for post-surgery healing. Several studies, including those from the National Institutes of Health (NIH) and the World Health Organization (WHO), have demonstrated that smoking weakens the immune system, delays and prolongs wound healing, increases the chance, severity and duration of infections at the wound site, and negatively impacts overall outcomes of surgical procedures and post operative complications.

Although the precise mechanisms are not entirely understood, the process of wound healing is intricate. However, it is estimated that cigarette smoke contains over 4,000 harmful substances, including nicotine, hydrogen cyanide and carbon monoxide. These compounds can induce inflammation and hypoxia (low blood oxygen), negatively impacting the healing process.

Nicotine, a key component of tobacco, has been shown to constrict blood vessels, leading to reduced blood flow to the wound site. This diminishes the delivery of oxygen and nutrients required for optimal healing. Moreover, nicotine inhibits the proliferation and migration of various cell types involved in wound healing, including fibroblasts and endothelial cells.

Through research, tobacco has also been shown to negatively influence bone healing, particularly in the context of fractures and orthopedic procedures. Smoking has been associated with delayed fracture healing, increased rates of nonunion (when bones fail to heal), and higher risks of implant failure.

The detrimental effects of tobacco on bone healing are attributed to multiple factors, including impaired blood flow, hypoxia, altered cellular activity, and disrupted signaling pathways crucial for bone regeneration. Furthermore, tobacco smoke has been found to have a negative impact on bone mineral density, increasing the risk of osteoporosis and subsequent fractures.

Impact on Treatment Outcomes and Implications for Workers’ Compensation

Understanding the impact of tobacco use on medical treatment and wound healing in workers' compensation has significant implications. One area of concern in treatment relates to the use of opioids for managing pain. Tobacco users tend to present with more severe and extended chronic pain, often requiring a higher frequency of opioid use. Interestingly, current tobacco use via traditional cigarettes or e-cigarettes, is a strong predictor for the potential risk of engaging in non-medical or non-prescription opioid use.   

Smoking has been associated with increased pain levels, longer hospital stays and reduced functional outcomes following surgery or medical interventions. The delayed healing and increased risk of complications associated with tobacco use can also lead to extended disability, protracted time away from work, and higher medical costs for employers and insurance providers. Recognizing the negative effects of smoking on treatment outcomes can influence the development of comprehensive workers' compensation programs that incorporate smoking cessation support as an integral part of tailored rehabilitation and recovery plans. By offering tobacco cessation interventions, employers and payers can help injured employees optimize their healing process, enhance treatment outcomes and aid in an overall quicker return to work.

Research has consistently demonstrated the detrimental effects of tobacco use on medical treatment outcomes and the healing process. Smoking delays wound and bone healing, increases the risk of complications following surgical procedures and interferes with the efficacy of certain medications. Understanding these effects is crucial for workers' compensation programs to develop comprehensive strategies that include smoking cessation support. By addressing tobacco use, employers can enhance treatment effectiveness, promote faster healing and ultimately improve the overall well-being and outcomes of injured employees within the workers' compensation system.

About the author

Cameron is a senior clinical pharmacist for Enlyte Pharmacy Solutions. In his role, he serves in a client facing capacity as part of the Pharmacy Benefit Management (PBM) team and is responsible for supporting and partnering with insurers, third party administrators and direct employers in developing and operationalizing strategic pharmacy initiatives for their clinical programs. Cameron has large retail chain pharmacy experience and has worked the past 6+ years within the workers’ comp PBM industry. 

Cameron is also a regular contributor to the Ask the Pharmacist Series where this article originally appeared.

www.mitchell.com/ask-the-pharmacist

References:

https://www.who.int/news/item/20-01-2020-smoking-greatly-increases-risk-of-complications-after-surgery#:~:text=Smoking%20distorts%20a%20patient's%20immune,nutrients%20for%20healing%20after%20surgery
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241583/
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00459-4/fulltext
https://pubmed.ncbi.nlm.nih.gov/26375198/#:~:text=Smokers%20present%20with%20more%20severe%20and%20extended%20chronic,of%20risk%20for%20nonmedical%20use%20of%20prescription%20opioids.

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