Early Drug Prescription Patterns as Predictors of Final Workers Compensation Claim Costs and Closure

Abstract

The aim of the study is to determine the associations of workers' compensation claim costs and return to work with drugs prescribed for early symptom management. Methods: Claims filed from 1998 to 2007 were followed for 10 years from the injury date. Drugs analyzed included gabapentin, pregabalin, antipsychotics, antidepressants, sedatives, benzodiazepines, carisoprodol, and opioids, controlling for initial reserve, sex, age, physical therapy, attorney involvement, and surgery. Results: Gabapentin, antipsychotics, antidepressants, and sedatives used in the first 3 months after injury were significantly associated with higher claim cost (≥$100,000). All opioid morphine equivalent doses greater than or equal to 5 mg/d for the first 6 months was significantly associated with higher cost (≥$100,000) and not being released to work at end of third year after injury with dose-response relationships. Conclusions: Prescription patterns in the first 3 months or first 6 months of workers' compensation claim development may be used as predictors of claim outcomes.

Dose Escalations Among Workers’ Compensation Claimants Using Opioid Medications—An 8 Year Postinjury Follow up Study

“…1), which is consistent with our previous research and by other authors. 3–7 9–16,18 However, the proportion of open claims with initially higher average opioid daily doses (≥ 15 MED/day) decline more rapidly because a higher proportion claimants associated with these open claims transition to no opioids (Fig. 2).…”

“…Prior workers' compensation research has documented that early opioid prescribing is associated with increased risk of opioid escalation and adverse patient and cost outcomes [3][4][5][6][7][8][9][10][11][12] but lower initial opioid dose and shorter duration are associated with better outcomes with regard to opioid discontinuation, claim cost, and claim duration. [16][17][18] When provided with adequate nonopioid analgesics, postoperative patients receiving low-dose opioids reported equivalent analgesia as postoperative patients receiving higher opioid doses. 39 Furthermore, pain management literature documents multiple alternative behavioral, exercise-based, and nonopioid pharmacologic treatments to either substitute for or supplement opioid analgesics.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] In previous research, the authors have also noted an association between prolonged opioid prescribing, increasing opioid dose, prolonged claim durations, and increased claims. [13][14][15][16][17][18][19] In addition, increasing prescription opioid dose has been associated with safety concerns, including increased risk of overdose and death. [20][21][22][23][24][25] Despite these findings, some studies reveal that opioids are being prescribed more liberally and for longer duration for occupational injuries than for nonwork-related injuries.…”

Secular trends in gabapentinoid dispensing by compensated workers with low back pain: a retrospective cohort study

“…1998 and 2007, saw that almost all participants (98%) did not receive a gabapentinoid within the first 6 months of their claim. 38 When a gabapentinoid was prescribed, it was associated with prolonged claim costs at 6 months. 38 Our study is the first to report trends in gabapentinoid use in a low back pain workers compensation population.…”

“…38 When a gabapentinoid was prescribed, it was associated with prolonged claim costs at 6 months. 38 Our study is the first to report trends in gabapentinoid use in a low back pain workers compensation population. Our results are from a robust, large, externally validated database documenting claimant activity since 1996 with very minimal missing data in our data set.…”