Abstract
There is a paucity of data on persistent opioid use and factors associated with persistent opioid use among workers' compensation claimants. To determine the proportion of injured workers who filled an opioid prescription beyond 90 days from injury and the factors associated with persistent opioid use among workers' compensation claimants. This retrospective cohort study collected workers' compensation claims data from January 1, 2008, to December 31, 2016, from the Chesapeake Employers' Insurance Company in Maryland. All workers' compensation claimants injured during the study years and with at least 1 filled opioid prescription were eligible for inclusion. For patients who had unique injury claims in multiple years of the study, only the first claimed injury was included in our analysis. Patients who died as a result of the claimed injury were excluded. The analysis was performed between October 2017 and August 2018. The primary outcome was persistent opioid use, defined as an opioid prescription fulfillment beyond 90 days from the date of injury. Multivariable regression was used to determine prognostic factors of persistent opioid use. Of the 9596 study participants (mean [SD] age, 43 [12.3] years; 6218 [65.1%] male), 2741 (28.6%) filled an opioid prescription more than 90 days from their date of injury. Participants aged 60 years or older (odds ratio [OR], 1.92; 95% CI, 1.56-2.36), crush injuries (OR, 1.55; 95% CI, 1.28-1.89), strain and sprain injuries (OR, 1.54; 95% CI, 1.36-1.75), annual income more than $60 000 (OR, 1.31; 95% CI, 1.07-1.61), and concomitant diagnoses for chronic joint pain (OR, 1.98; 95% CI, 1.79-2.20) were significantly associated with persistent opioid use. Compared with workers with claims designated as permanent partial disability, workers with medical-only claims were significantly less likely to have persistent opioid use at 90 days postinjury (OR, 0.17; 95% CI, 0.15-0.20). A high proportion of persistent opioid use was observed in this workers' compensation cohort. Interventions to lower persistent opioid use in this population should target patients with the characteristics identified in this study.
Highlights
Participants aged 60 years or older, crush injuries (OR, 1.55; 95% CI, 1.28-1.89), strain and sprain injuries (OR, 1.54; 95% CI, 1.36-1.75), annual income more than $60 000 (OR, 1.31; 95% CI, 1.07-1.61), and concomitant diagnoses for chronic joint pain (OR, 1.98; 95% CI, 1.79-2.20) were significantly associated with persistent opioid use
Compared with workers with claims designated as permanent partial disability, workers with medical-only claims were significantly less likely to have persistent opioid use at 90 days postinjury (OR, 0.17; 95% CI, 0.15-0.20)
89 007 study participants were excluded from the data for not having a single opioid prescription filled as part of their insurance claim
Summary
In 2016, more than 11.5 million Americans aged 12 years or older (4.4% of the population) reported misuse of prescription opioids and more than 14 000 people died from overdoses involving prescription opioids in the United States.[1,2] Despite these known risks and very little evidence to support long-term opioid therapy for pain management, at least 214 million opioid prescriptions were dispensed every year in the United States since 2006.3,4 In response, the US Department of Health and Human Services declared a public health emergency in October 2017 to address the national opioid crisis.[5]. Persistent opioid use in injured workers were previously linked with more costly claims and attributed to an overall loss in work productivity.[7,8] The factors that led to persistent opioid use or dependence are unknown. This study of workers’ compensation records may provide a unique insight into 18 to 65 years of age group most at risk for an opioid misuse, addiction, or overdose.[9]
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