Safety and OSHA News

What leads to long-term opioid use after a workplace injury?

A new study reveals six factors that can lead to long-term opioid use for employees injured at work and who weren’t previously taking the prescription painkillers. 

The strongest factor associated with long-term opioid use was receiving 20 or more days supply in their first prescription, followed by visiting three or more prescribers within 90 days of injury.

In the study of 46,399 Tennessee workers, 4% (1,843) began long-term opioid use after their workplace injury.

The other related factors are:

  • receiving a long-acting opioid within 30 days of injury
  • overlapping opioid and benzodiazepine prescription
  • visiting three or more pharmacies within 90 days of injury, and
  • receiving maximum dosage within 30 days of injury.

The study notes even just five to nine days’ supply of an opioid was associated with an increase in the odds of long-term use, compared with less than five days’ supply.

(The U.S. Centers for Disease Control and Prevention guidelines call for providing the lowest dose of a short-acting opioid for the fewest days possible – preferably three and no more than seven days.)

“Addressing injury as a gateway to long-term opioid use is an important step toward curbing the opioid epidemic,” the study states.

For injured workers, prescribing practices appear to be more closely linked with long-term opioid use than demographic characteristics (age, gender, race, etc.).

“Unlike patient demographic characteristics, prescribing may be modified to reduce patient risk,” the study concludes.

Of course, the study also points to one more solution for employers: Prevent employee injuries in the first place, removing the need for a prescription painkiller.

What else can employers do to reduce opioid usage among their employees?

  • Discuss a limit on the number of pills on initial opioid prescriptions with your insurers, particularly workers’ comp
  • Limit coverage of opioids to a network of pharmacies and providers
  • Expand coverage for pain management alternatives, such as physical therapy, even if these options are initially more expensive
  • Monitor workers’ comp claims to see if opioid prescriptions are being used as a low-cost option
  • Provide employee training to increase awareness about opioid use, and
  • Revisit and enhance your drug counseling programs.

The studyPrevalence and Risk Factors Associated with Long-term Opioid Use After Injury Among Previously Opioid-Free Workers, was published in JAMA Network Open.

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  1. Here we go again – let’s put this problem on employers and have them monitor things even more stringently than they already do!
    I note that the “strongest factor” identified here is patients “receiving 20 or more days supply in their first prescription”, followed by visiting multiple prescribers, and then “receiving a long-acting opioid within 30 days of injury” – those are all issues the medical system should be rigorously controlling. A couple of years ago I had an employee suffer a superficial corneal abrasion at work. It was nothing life-threatening or even vison-threatening, though it obviously was uncomfortable. The treating physician’s first visit (initial examination & diagnosis), first-try solution at “pain management” was a 30-day prescription for oxycodone! That has got to be considered malpractice, and certainly goes against everything outlined in this article and many others I’ve read on the topic of opioid use/abuse – but this was a Dr. making a “medical decision”, so everything about the system says he has the right to make these stupid choices and as a non-medical professional I have little to no right to challenge directly about it.
    So it’s not employers who need to do more. To get real progress in this fight the medical system, particularly the prescribers, have once and for all got to face up to the role (and irresponsibility) they’ve played in fostering the current opioid epidemic, get their s**t together, and stop practicing bad medicine. Physician heal thyself!

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