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Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort.

Authors
Franklin-GM; Stover-BD; Turner-JA; Fulton-Kehoe-D; Wickizer-TM
Source
Spine 2008 Jan; 33(2):199-204
NIOSHTIC No.
20033146
Abstract
STUDY DESIGN: Prospective, population-based cohort study. OBJECTIVE: To examine whether prescription of opioids within 6 weeks of low back injury is associated with work disability at 1 year. SUMMARY OF BACKGROUND DATA: Factors related to early medical treatment have been little investigated as possible risk factors for development of long-term work disability among workers with back injuries. We have previously shown that about 1 of 3 of workers receive an opioid prescription early after a low back injury, and a recent study suggested that such prescriptions may increase risk for subsequent disability. METHODS: We analyzed detailed data reflecting paid bills for opioids prescribed within 6 weeks of the first medical visit for a back injury among 1843 workers with lost work-time claims. Additional baseline measures included an injury severity rating from medical records, and demographic, psychosocial, pain, function, smoking, and alcohol measures from a worker survey conducted 18 days (median) after receipt of the back injury claim. Computerized database records of work disability 1 year after claim submission were obtained for the primary outcome measure. RESULTS: Nearly 14% (254 of 1843) of the sample were receiving work disability compensation at 1 year. More than one-third of the workers (630 of 1843) received an opioid prescription within 6 weeks, and 50.7% of these (319 of 630) were received at the first medical visit. After adjustment for pain, function, injury severity, and other baseline covariates, receipt of opioids for more than 7 days (odds ratio = 2.2; 95% confidence interval, 1.5-3.1) and receipt of more than 1 opioid prescription were associated significantly with work disability at 1 year. CONCLUSION: Prescription of opioids for more than 7 days for workers with acute back injuries is a risk factor for long-term disability. Further research is needed to elucidate this association.
Keywords
Workers; Worker-health; Disabled-workers; Injuries; Traumatic-injuries; Risk-analysis; Risk-factors; Demographic-characteristics; Drug-therapy; Drug-interaction; Back-injuries; Pain-tolerance; Work-capability; Work-performance
Contact
Gary M. Franklin, MD, MPH, Department of Environmental and Occupational Health Sciences, University of Washington, 1914 N. 34th Street, 101, Seattle, WA 98103
CODEN
SPINDD
Publication Date
20080115
Document Type
Journal Article
Email Address
meddir@u.washington.edu
Funding Type
Grant
Fiscal Year
2008
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-004069
Issue of Publication
2
ISSN
0362-2436
Source Name
Spine
State
WA
Performing Organization
University of Washington
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