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Opioid dosing trends and mortality in Washington State workers' compensation, 1996-2002.

Authors
Franklin-GM; Mai-J; Wickizer-T; Turner-JA; Fulton-Kehoe-D; Grant-L
Source
Am J Ind Med 2005 Aug; 48(2):91-99
NIOSHTIC No.
20028810
Abstract
The use of opioids for chronic non-cancer pain has increased in the United States since state laws were relaxed in the late 1990s. These policy changes occurred despite scanty scientific evidence that chronic use of opioids was safe and effective. We examined opiate prescriptions and dosing patterns (from computerized databases, 1996 to 2002), and accidental poisoning deaths attributable to opioid use (from death certificates, 1995 to 2002), in the Washington State workers' compensation system. Opioid prescriptions increased only modestly between 1996 and 2002. However, prescriptions for the most potent opioids (Schedule II), as a percentage of all scheduled opioid prescriptions (II, III, and IV), increased from 19.3% in 1996 to 37.2% in 2002. Among long-acting opioids, the average daily morphine equivalent dose increased by 50%, to 132 mg/day. Thirty-two deaths were definitely or probably related to accidental overdose of opioids. The majority of deaths involved men (84%) and smokers (69%). The reasons for escalating doses of the most potent opioids are unknown, but it is possible that tolerance or opioid-induced abnormal pain sensitivity may be occurring in some workers who use opioids for chronic pain. Opioid-related deaths in this population may be preventable through use of prudent guidelines regarding opioid use for chronic pain.
Keywords
Workers; Mortality-rates; Mortality-data; Worker-health; Poisons; Drugs; Smoking; Demographic-characteristics; Sex-factors
Contact
Gary M. Franklin, Research Professor, Department of Environmental and Occupational Health Sciences, University of Washington, 1914 N. 34th Street, no. 101, Seattle, WA 98103
CODEN
AJIMD8
Publication Date
20050801
Document Type
Journal Article
Email Address
meddir@u.washington.edu
Funding Type
Grant
Fiscal Year
2005
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-004069
Issue of Publication
2
ISSN
0271-3586
Source Name
American Journal of Industrial Medicine
State
WA
Performing Organization
University of Washington
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