Abstract
Using opioids for acute pain can lead to long-term use and associated morbidity and mortality. Injury has been documented as a gateway to long-term opioid use in some populations, but data are limited for injured workers. To evaluate the prevalence and risk factors of long-term opioid use after injury among workers in Tennessee who were opioid free at the time of injury. This cohort study identified injured workers aged 15 to 99 years who reported only 1 injury to the Tennessee Bureau of Workers' Compensation from March 2013 to December 2015 and had no opioid prescription in the 60 days before injury. Participants were matched to their prescription history in Tennessee's prescription drug monitoring program. Analysis was conducted from November 2017 to March 2018. Logistic regression models were used to calculate adjusted odds ratios (ORs) and 95% CIs for associations of demographic, injury, and opioid use variables with long-term use. The primary outcome was long-term opioid use, defined as having an opioid supplied for 45 or more days in the 90 days after injury. Among 58 278 injured workers who received opioids after injury (18 977 [32.5%] aged 15-34 years, 27 514 [47.2%] aged 35-54 years, and 11 787 [20.2%] aged 55-99 years; 32 607 [56.0%] men), 46 399 (79.6%) were opioid free at the time of injury. Among opioid-free injured workers, 1843 (4.0%) began long-term opioid use. After controlling for covariates, long-term use was associated with receiving 20 or more days' supply in the initial opioid prescription compared with receiving less than 5 days' supply (OR, 28.94; 95% CI, 23.44-35.72) and visiting 3 or more prescribers in the 90 days after injury compared with visiting 1 prescriber (OR, 14.91; 95% CI, 12.15-18.29). However, even just 5 days' to 9 days' supply was associated with an increase in the odds of long-term use compared with less than 5 days' supply (OR, 1.83; 95% CI, 1.56-2.14). In this study of injured workers, injury was associated with long-term opioid use. The number of days' supply of the initial opioid prescription was the strongest risk factor of developing long-term use, highlighting the importance of careful prescribing for initial opioid prescriptions.
Highlights
Long-term opioid use is about more than the number of days someone takes an opioid; it is about the threshold at which the costs of opioid use begin to outweigh the advantages
After controlling for covariates, long-term use was associated with receiving 20 or more days’ supply in the initial opioid prescription compared with receiving less than 5 days’ supply (OR, 28.94; 95% CI, 23.44-35.72) and visiting 3 or more prescribers in the 90 days after injury compared with visiting 1 prescriber (OR, 14.91; 95% CI, 12.15-18.29)
Research on long-term opioid use for chronic pain was summarized in a systematic review of clinical trials and observational studies,[1] which reported no evidence of effectiveness for opioid use of greater than 3 months but increased risk of harms, including overdose, substance use disorder, fractures, and myocardial infarction
Summary
Long-term opioid use is about more than the number of days someone takes an opioid; it is about the threshold at which the costs of opioid use begin to outweigh the advantages. An epidemiological study[2] showed that long-term opioid use is associated with dependence, addiction, poor self-rated health, inactivity, unemployment, higher health care utilization, and poor self-rated quality of life. Long-term opioid therapy is associated with higher health care costs[3] and lower productivity.[4]. Associations with opioid use after 90 days were found for older age (Ն60 years vs 15-29 years: odds ratio [OR], 1.92; 95% CI, 1.56-2.36), higher annual income (Ն$60 000 vs
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