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Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort.
Franklin-GM; Stover-BD; Turner-JA; Fulton-Kehoe-D; Wickizer-TM
Spine 2008 Jan; 33(2):199-204
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.
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
Gary M. Franklin, MD, MPH, Department of Environmental and Occupational Health Sciences, University of Washington, 1914 N. 34th Street, 101, Seattle, WA 98103
Issue of Publication
University of Washington
Page last reviewed: May 5, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division