Open Access Open Access  Restricted Access Subscription or Fee Access

Opioid use: Case-control analyses of worker's compensation data

Ulrike Ott, PhD, MSPH, Matthew S. Thiese, PhD, MSPH, Brenden B. Ronna, BS, Kristine Hegmann, MSPH, CIC, Kurt T. Hegmann, MD, MSPH

Abstract


Objectives: Working-age adults are disproportionately impacted by opioid misuse. Factors associated with opioid misuse in people with workers compensation (WC) claims are not well studied. WC in some states is a “captured” market making it a more efficient site for researching the opioids epidemic. A pilot study was conducted to identify factors associated with opioid use using a large WC insurer's claims in Utah.

Methods: This was a case-control study using a large WC insurer's database. We conducted secondary data analyses of a de-identified dataset originally obtained from the WC insurer. Cases were defined as claims with a morphine equivalent dose (MED) ≥50 mg/d in the 30 days after the claim was filed while controls = 0 mg/d.

Results: A total of 76 patient's claims (28 cases and 48 controls) were included in the final data analyses. The majority of claimants were male (N = 50, 65.8 percent), worked full time (N = 58, 76.3 percent) and had a mean age of 37.0 ± 11.4 years. The majority of controls filed medical only claims (N = 40, 83.3 percent) while the majority of cases filed indemnity claims (N = 19, 67.9 percent). Cases were prescribed a mean MED of 126.4 (SD = 93.3) within the first month after filing the claim. Most cases visited > 3 medical providers (N = 13, 46.4 percent) in the first month after filing the claim while the majority of controls only visited one provider (N = 28, 58.3 percent). Remarkably, the mean number of providers visited within the first month for the cases was 3.8, which was 2-fold greater than the control group. Exploratory multivariate analyses showed that cases were 4.6 times more likely to have visited 2-3 medical providers (p = 0.025), and 41.8 times more likely to have visited more than three medical providers (p < 0.001). Cases had 3.6 higher odds of having been prescribed nonsteroidal anti-inflammatory prescription within the first month as compared to controls (p = 0.014).

Conclusion: This pilot study found risk factors, some of which may be modifiable. We aim to conduct a large study using existing WC data to create a scoring system that identifies those claimants at higher risk of adverse opioid-related events that may have preventive applications at a systems-level.


Keywords


opioids, occupational health, worker health, case control, risk factors

Full Text:

PDF

References


Caudill-Slosberg MA, Schwartz LM, Woloshin S: Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs. 2000. Pain. 2004; 109(3): 514-519.

Berecki-Gisolf J, Collie A, McClure RJ: Prescription opioids for occupational injury: Results from workers' compensation claims records. Pain Med. 2014; 15(9): 1549-1557.

Hayes S, Swedlow A: Pain Management and the Use of Opioids in the Treatment of Back Conditions in the California Workers Compensation System. 2016. Available at: https://www.cwci.org/document.php?file=2957.pdf. Accessed February 1, 2017.

Park TW, Lin LA, Hosanagar A, et al.: Understanding risk factors for opioid overdose in clinical populations to inform treatment and policy. J Addict Med. 2016; 10(6): 369-381.

Heins SE, Feldman DR, Bodycombe D, et al.: Early opioid prescription and risk of long-term opioid use among US workers with back and shoulder injuries: A retrospective cohort study. Inj Prev. 2016; 22(3): 211-215.

Beaudoin FL, Banerjee GN, Mello MJ: State-level and system-level opioid prescribing policies: The impact on provider practices and overdose deaths, a systematic review. J Opioid Manag. 2016; 12(2): 109-118.

Delorme J, Chenaf C, Kabore JL, et al.: Incidence of high dosage buprenorphine and methadone shopping behavior in a retrospective cohort of opioid-maintained patients in France. Drug Alcohol Depend. 2016; 162: 99-106.

Dilokthornsakul P, Moore G, Campbell JD, et al.: Risk factors of prescription opioid overdose among Colorado Medicaid Beneficiaries. J Pain: Off J Am Pain Soc. 2016; 17(4): 436-443.

Weiner SG, Griggs CA, Langlois BK, et al.: Characteristics of emergency department “doctor shoppers”. J Emerg Med. 2015; 48(4): 424-431 (e421).

Cheng M, Sauer B, Johnson E, et al.: Comparison of opioid-related deaths by work-related injury. Am J Industrial Med. 2013; 56(3): 308-316.

Lipton B, Collón D: Workers Compensation and Prescription Drugs: 2016 Update2016. Available at: https://www.ncci.com/Articles/Documents/II_IR2016-Fall-Lipton-Colon.pdf. Accessed February 1, 2017.

Centers for Disease Control and Prevention. Injury Prevention & Control: Prescription Opioid Overdose Data. Available at https://www.cdc.gov/drugoverdose/data/overdose.html. Accessed February 1, 2017.

Dunn KM, Saunders KW, Rutter CM, et al.: Opioid prescriptions for chronic pain and overdose: A cohort study. Ann Intern Med. 2010; 152(2): 85-92.

Gomes T, Redelmeier DA, Juurlink DN, et al.: Opioid dose and risk of road trauma in Canada: A population-based study. JAMA Intern Med. 2013; 173(3): 196-201.

Calcaterra S, Glanz J, Binswanger IA: National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009. Drug Alcohol Depend. 2013; 131(3): 263-270.

Centers for Disease Control and Prevention. Injury Prevention & Control: Opioid Overdose. Available at https://www.cdc.gov/drugoverdose/data/analysis.html. Accessed January 27, 2017.

Franklin GM, Mai J, Wickizer T, et al.: Opioid dosing trends and mortality in Washington State workers' compensation, 1996-2002. Am J Industrial Med. 2005; 48(2): 91-99.

Levy B, Paulozzi L, Mack KA, et al.: Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012. Am J Prev Med. 2015; 49(3): 409-413.

Vowles KE, McEntee ML, Julnes PS, et al.: Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Pain. 2015; 156(4): 569-576.

Florence CS, Zhou C, Luo F, et al.: The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care. 2016; 54(10): 901-906.

Vogt MT, Kwoh CK, Cope DK, et al.: Analgesic usage for low back pain: impact on health care costs and service use. SPINE (Phila Pa 1976). 2005 May 1; 30(9): 1075-1081.

Volinn E, Fargo JD, Fine PG: Opioid therapy for nonspecific low back pain and the outcome of chronic work loss. Pain. 2009; 142(3): 194-201.

Birnbaum HG WA, Schiller M, et al.: Societal costs of opioid abuse, dependence, and misuse in the United States. Pain Med. 2011; 12(4): 657–667.

Tanne JH: Deaths from prescription opioids soar in New York. BMJ. 2013; 346: f921.

Rudd RA, Aleshire N, Zibbell JE, et al.: Increases in drug and opioid overdose deaths — United States, 2000–2014. Morb Mortal Wkly Rep (MMWR). 2016; 64(50): 1378-1382.

Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep. 2016; 65(1): 1-49.

Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016; 315(15): 1624-1645.

Dembe A, Wickizer T, Sieck C, et al.: Opioid use and dosing in the workers' compensation setting. A comparative review and new data from Ohio. Am J Industrial Med. 2012; 55(4): 313-324.

Shafer LA, Raymond C, Ekuma O, et al.: The impact of opioid prescription dose and duration during a workers compensation claim, on post-claim continued opioid use: A retrospective population- based study. Am J Industrial Med. 2015; 58(6): 650-657.

Gross DP, Stephens B, Bhambhani Y, et al.: Opioid prescriptions in canadian workers' compensation claimants: Prescription trends and associations between early prescription and future recovery. Spine. 2009; 34(5): 525-531.

Johnston SS, Alexander AH, Masters ET, et al.: Costs and work loss burden of diagnosed opioid abuse among employees on workers compensation or short-term disability. J Occup Environ Med / Am College Occup Environ Med. 2016; 58(11): 1087-1097.

Naliboff BD, Wu SM, Schieffer B, et al.: A randomized trial of 2 prescription strategies for opioid treatment of chronic nonmalignant pain. J Pain. 2011; 12(2): 288-296.

Hegmann KT, Weiss MS, Bowden K, et al.: ACOEM practice guidelines: Opioids for treatment of acute, subacute, chronic, and postoperative pain. J Occup Environ Med/Am College Occup Environ Med. 2014; 56(12): e143-e159.

Hegmann KT, Weiss MS, Bowden K, et al.: ACOEM practice guidelines: Opioids and safety-sensitive work. J Occup Environ Med / Am College Occup Environ Med. 2014; 56(7): e46-e53.

Strassels SA: Economic burden of prescription opioid misuse and abuse. J Managed Care Pharm: JMCP. 2009; 15(7): 556-562.

Wasan AD, Davar G, Jamison R: The association between negative affect and opioid analgesia in patients with discogenic low back pain. Pain. 2005; 117(3): 450-461.

Webster BS, Verma SK, Gatchel RJ: Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use. Spine. 2007; 32(19): 2127-2132.

Franklin GM, Stover BD, Turner JA, et al.: Disability Risk Identification Study C. Early opioid prescription and subsequent disability among workers with back injuries: The Disability Risk Identification Study Cohort. Spine. 2008; 33(2): 199-204.

Group AMD: Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain: An educational aid to improve care and safety with opioid therapy. 2010 Update. Available at http://www.agencymeddirectors.wa.gov/files/opioidgdline.pdf. Accessed March 8, 2017.

Bachs LC, Engeland A, Morland JG, et al.: The risk of motor vehicle accidents involving drivers with prescriptions for codeine or tramadol. Clin Pharmacol Therap. 2009; 85(6): 596-599.

Wilsey BL, Fishman SM, Gilson AM, et al.: Profiling multiple provider prescribing of opioids, benzodiazepines, stimulants, and anorectics. Drug Alcohol Depend. 2010; 112(1-2): 99-106.

Stover BD, Turner JA, Franklin G, et al.: Factors associated with early opioid prescription among workers with low back injuries. J Pain: Off J Am Pain Soc. 2006; 7(10): 718-725.

Yang Z, Wilsey B, Bohm M, et al.: Defining risk of prescription opioid overdose: Pharmacy shopping and overlapping prescriptions among long-term opioid users in medicaid. J Pain: Off J Am Pain Soc. 2015; 16(5): 445-453.

Turner BJ, Liang Y: Drug overdose in a retrospective cohort with non-cancer pain treated with opioids, antidepressants, and/or sedative-hypnotics: Interactions with mental health disorders. J Gen Intern Med. 2015; 30(8): 1081-1096.

Fink DS, Hu R, Cerda M, et al.: Patterns of major depression and nonmedical use of prescription opioids in the United States. Drug Alcohol Depend. 2015; 153: 258-264.




DOI: https://doi.org/10.5055/jom.2018.0459

Refbacks

  • There are currently no refbacks.