The Journal of the American Medical Association (JAMA) recently published Factors Associated With Persistent Opioid Use Among Injured Workers’ Compensation Claimants, a cohort study designed to understand the proportion of persistent opioid use among this population, along with patient-level factors associated with persistent opioid use.
The study examined 9,596 workers’ comp claimants in the Chesapeake Employers Insurance Company in Maryland who initially filled at least one opioid prescription between January 1, 2008 and December 31, 2016. It was found that roughly 30% of patients continued to fill opioid prescriptions 90 days beyond injury, with about 20% of patients still filling opioid prescriptions beyond 180 days. Nearly 10% of patients continued opioid use one year past injury.
Furthermore, the study also identified factors associated with persistent opioid use, including:
- Increased age (60 or older)
- Pre-injury income above $60,000
- Disability status (permanent partial disability vs medical only)
- Injury type (e.g., crush injuries, sprain and strain, open wound)
- Chronic pain diagnosis (e.g., chronic joint pain, migraines, fibromyalgia)
The study recommended targeting interventions to workers’ comp patients who exhibited these attributes, as well as not initiating opioid therapy for non-severe injuries.
However, the study also noted that the current structure of Maryland’s workers’ comp system could also play a factor in these numbers, which allows disputes over medical issues to be decided in a legal setting, where continued opioid prescriptions can be used to legally support a continued injury claim. The study notes that this structure may “unintentionally encourage persistent opioid use.”