Impact of Opioid Use on Duration of Time Loss After Work-Related Lower Limb Injury

Abstract

Purpose This study sought to determine patterns of opioid use among workers with a compensated lower limb injury, factors associated with opioid use, and how opioid use is associated with time loss duration. Methods Claims and medication data were provided by the workers’ compensation regulator of Victoria, Australia, for claims lodged 2008–2018 from workers aged 15+ years with a lower limb injury. Descriptive statistics showed the number and prevalence of each opioid type (weak/strong) by demographic, claim and injury predictors. Binary and multinomial logistic regression determined the likelihood of any opioid use, and use of strong, weak or a combination of strong and weak opioids by predictors. Cox regression determined the effect of each opioid type on duration of time loss, controlling for predictors. Results There were 51,334 claims and of these 23.6% were dispensed opioids (9.2% for strong opioids only, 6.6% for weak opioids only and 7.8% for a combination). Weak opioids, on average, were dispensed 15 days earlier than strong opioids. Time loss claims and workers with fractures or hip injuries were most likely to be dispensed opioids. All opioids were associated with increased duration of time loss, with those dispensed both weak and strong opioids having the longest duration of time loss. Conclusions Any opioid use was associated with longer time loss duration, with increasing opioid strength having a greater effect. Review of pain management methods should be undertaken to reduce opioid use, which may have a positive impact on duration of time loss and long-term function.

The Association of Physiotherapy and Opioid Use With Duration of Compensated Time Loss for Workers With Low Back Pain

“…26 Stronger opioids can also lead to a greater risk of prolonged work disability, 29 and prolonged usage is likely to cause tolerance, resulting in a stronger dose being required. 50 Therefore, the observed longer duration of time loss could be attributed to the difference in strength and volume of opioids accessed, both of which were not investigated in this study. Another potential explanation for the result is that those receiving opioids might be doing so because they are in more pain and disability.…”

“…26 Policy features of the included workers' compensation schemes, such as the medical excess amount, were likely to have influenced the results. 36,40,50 In Victoria, employers are required to pay a medical excess up to a nominal value (approx. $700 AUD at the time of the study) before workers' compensation takes over.…”

“…Time of access, strength, and volume of opioids can influence the duration of time loss. 28,29,50 For example, one study found that opioid prescriptions within the first 4 weeks of a worker's claim were found to be associated with a longer duration of time loss. 26 Stronger opioids can also lead to a greater risk of prolonged work disability, 29 and prolonged usage is likely to cause tolerance, resulting in a stronger dose being required.…”

Impact of Prescription Medicines on Work-Related Outcomes in Workers with Musculoskeletal Disorders or Injuries: A Systematic Scoping Review

“…One prospective and four retrospective cohort studies in people with MSDs reported either high dose, strong or long-term opioid prescriptions were associated with increased lost workdays, including a study on patients admitted to interdisciplinary functional restoration [ 66 ], employed workers with osteoarthritis [ 60 ] and WC claimants [ 65 , 74 ] and a study of workers with lower limb injury [ 63 ]. Similarly, a retrospective cohort study on persons injured with motor vehicle accident also reported early opioid prescriptions (within 10 days of accident) were a risk factor for work disability ≥ 6 months after the accident [ 64 ].…”

Factors influencing pain medication and opioid use in patients with musculoskeletal injuries: a retrospective insurance claims database study

“…In the United Kingdom, primary care physicians prescribed opioids in 59% of patients with chronic musculoskeletal pain in 2011/2012 30 . In Australia 23.6% of workers with lower limb injury claims received opioids and opioid use was associated with delayed return to work 41 . In the U.S., the prevalence of prescribed opioids in MSK conditions (back or neck problems, arthritis, rheumatism) increased by 7% from 12% in 1999/2000 to 19% in 2015/2016 42 .…”