Baltimore, MD (WorkersCompensation.com) – A new report has found that 30 percent of injured workers prescribed opioids are still taking them 3 months after their injuries, increasing the likelihood they will become addicted.
“The increased likelihood of persistent opioid use among strain and sprain injuries is potentially concerning, particularly given the limited evidence to support opioid therapy for these injuries,” said study lead author Nathan O’Hara a research associate at the University of Maryland School of Medicine’s department of orthopedics, in Baltimore.
The study, published in October 2018 in the Journal of the American Medical Association Network Open, found that of 9,596 workers’ compensation claimants initially treated with an opioid prescription, nearly one third of them, or 2,741, continued to fill that prescription 90 days after the injury. Those most likely to continue opioid use were older, made more than $60,000 before the injury, had injuries from being crushed, or straining/spraining a body part and had a concomitant diagnosis of chronic joint pain.
The study showed that of the nearly 9,600 claims, 1,762, or nearly 20 percent were still filling their opioid prescription more than 180 days after the injury, and 902, or nearly 10 percent, were still on their opioid prescriptions one year after their injury.
O’Hara said it was a growing problem.
“Since persistent opioid use does not correlate well with injury severity, consideration should be given to not initiating opioid use for non-severe injuries,” he said in the study.
The study looked at workers’ compensation claims from the Chesapeake Employers’ Insurance Company in Maryland, and covered claims from Jan. 1, 2008 to Dec. 31, 2016. All claimants injured during the study years and with at least one filled opioid prescription were included in the study.
Of the more than 100,000 claims, 89,007 were not eligible for the study, and 83,862 did not ever have an opioid prescription.
When looking at the data, the report found that chronic pain injuries were more likely to result in long-term use of opioids, as were crush injuries. Workers who were 60 or older were more likely to be on opioids for more than 90 days, as were employees who did not have full-time employment prior to their injury.
But for long-term use, workers with chronic back pain diagnosis were more likely to have persistent opioid use, and surgical treatment for the injury was only nominally protective against opioid dependency, according to the study.
The study also found that some of the cause of the dependence may be in Maryland’s Workers’ Compensation system itself.
“The current structure of adjudication and compensation for work-related injuries in Maryland may unintentionally encourage persistent opioid use,” the study said. “The design of the Maryland Workers’ Compensation system is to allow disputes over medical issues to be adjudicated in a legal setting. The decisions may reflect the nature of the medical supporting documents and presentation as the basis for a legal decision rather than an accurate reflection of the medical condition. Continued prescriptions for pain management can be used to legally support a continued injury claim. Also of note is the strong association between unspecific types of injuries and persistent opioid use. A lack of specificity in diagnosis may prolong delays in treatment, recovery, and return to work.”
Gerard Slobogean, an assistant professor of orthopedics at the University of Maryland School of Medicine and one of the study’s authors, told HealthNews Daily that the concern shared by many doctors is the use of opioids for non-acute pain.
“Physical therapy, other complementary and alternative therapies, as well as non-opioid medical therapies, should be considered for many injured workers,” he said.
Experts on addiction agree.
Lindsey Vuolo, associate director for health law and policy at the Center on Addiction said, “The high rate of persistent opioid use among injured workers in this study is concerning because such use may signify misuse, a risk factor for opioid use disorder.”
In 2016, more than 11.5 million Americans reported misusing prescription opioids, and more than 14,000 people died from prescription opioid overdoses, according to the study.
Vuolo said, in an interview with WorkersCompensation.com, the study shows that solving the opioid crisis means work on all sides of the workers’ compensation equation – from finding alternative ways to manage chronic pain in employees after injuries, to increasing education and providing screening for employees more likely to develop opioid dependency, to ensuring that employers have programs and policies in place to help employees who may develop opioid dependency after an injury.