Opioid poisonings and opioid adverse effects in workers in Washington State

Fulton‐Kehoe, Deborah; Garg, Renu; Turner, Judith A.; Bauer, Amy M.; Sullivan, Mark D.; Wickizer, Thomas M.; Franklin, Gary M.

doi:10.1002/ajim.22266

Cited by 44 publications

(24 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, given differing potency of long-acting oxycodone, there is potential for dosing errors that could lead to accidental opioid overdoses. Lastly, this increase may be related to the increasing prevalence of high-dose opioid use, which aligns with findings following the release to the Washington State guidelines [24], and suggests that guidelines and legislation alone may not be sufficient to reduce opioid-related toxicity, particularly in an environment of increasing prevalence of high-dose opioid use…”

Section: Discussionmentioning

confidence: 62%

High-Dose Opioid Prescribing and Opioid-Related Hospitalization: A Population-Based Study

et al. 2016

View full text Add to dashboard Cite

AimsTo examine the impact of national clinical practice guidelines and provincial drug policy interventions on prevalence of high-dose opioid prescribing and rates of hospitalization for opioid toxicity.DesignInterventional time-series analysis.SettingOntario, Canada, from 2003 to 2014.ParticipantsOntario Drug Benefit (ODB) beneficiaries aged 15 to 64 years from 2003 to 2014.InterventionsPublication of Canadian clinical practice guidelines for use of opioids in chronic non-cancer pain (May 2010) and implementation of Ontario’s Narcotics Safety and Awareness Act (NSAA; November 2011).MeasurementsThree outcomes were explored: the rate of opioid use among ODB beneficiaries, the prevalence of opioid prescriptions exceeding 200 mg and 400 mg morphine equivalents per day, and rates of opioid-related emergency department visits and hospital admissions.FindingsOver the 12 year study period, the rate of opioid use declined 15.2%, from 2764 to 2342 users per 10,000 ODB eligible persons. The rate of opioid use was significantly impacted by the Canadian clinical practice guidelines (p-value = .03) which led to a decline in use, but no impact was observed by the enactment of the NSAA (p-value = .43). Among opioid users, the prevalence of high-dose prescribing doubled (from 4.2% to 8.7%) over the study period. By 2014, 40.9% of recipients of long-acting opioids exceeded daily doses of 200 mg morphine or equivalent, including 55.8% of long-acting oxycodone users and 76.3% of transdermal fentanyl users. Moreover, in the last period, 18.7% of long-acting opioid users exceeded daily doses of 400 mg morphine or equivalent. Rates of opioid-related emergency department visits and hospital admissions increased 55.0% over the study period from 9.0 to 14.0 per 10,000 ODB beneficiaries from 2003 to 2013. This rate was not significantly impacted by the Canadian clinical practice guidelines (p-value = .68) or enactment of the NSAA (p-value = .59).ConclusionsAlthough the Canadian clinical practice guidelines for use of opioids in chronic non-cancer pain led to a decline in opioid prescribing rates among ODB beneficiaries these guidelines and subsequent Ontario legislation did not result in a significant change in rates of opioid-related hospitalizations. Given the prevalence of high dose opioid prescribing in this population, this suggests that improved strategies and programs for the safe prescribing of long-acting opioids are needed.

show abstract

Section: Discussionmentioning

confidence: 62%

High-Dose Opioid Prescribing and Opioid-Related Hospitalization: A Population-Based Study

et al. 2016

View full text Add to dashboard Cite

show abstract

“…68 Similarly, in a workers' compensation system, most opioid overdoses occurred in patients who were not receiving high dose or long term opioids. 94 Thus, efforts to reduce overdose risks may need to extend to all patients receiving prescription opioids.…”

Section: Urine Drug Screensmentioning

confidence: 99%

Opioids for low back pain

Deyo

Korff

Duhrkoop³

2015

BMJ

429

329

View full text Add to dashboard Cite

Back pain affects most adults, causes disability for some, and is a common reason for seeking healthcare. In the United States, opioid prescription for low back pain has increased, and opioids are now the most commonly prescribed drug class. More than half of regular opioid users report back pain. Rates of opioid prescribing in the US and Canada are two to three times higher than in most European countries. The analgesic efficacy of opioids for acute back pain is inferred from evidence in other acute pain conditions. Opioids do not seem to expedite return to work in injured workers or improve functional outcomes of acute back pain in primary care. For chronic back pain, systematic reviews find scant evidence of efficacy. Randomized controlled trials have high dropout rates, brief duration (four months or less), and highly selected patients. Opioids seem to have short term analgesic efficacy for chronic back pain, but benefits for function are less clear. The magnitude of pain relief across chronic non-cancer pain conditions is about 30%. Given the brevity of randomized controlled trials, the long term effectiveness and safety of opioids are unknown. Loss of long term efficacy could result from drug tolerance and emergence of hyperalgesia. Complications of opioid use include addiction and overdose related mortality, which have risen in parallel with prescription rates. Common short term side effects are constipation, nausea, sedation, and increased risk of falls and fractures. Longer term side effects may include depression and sexual dysfunction. Screening for high risk patients, treatment agreements, and urine testing have not reduced overall rates of opioid prescribing, misuse, or overdose. Newer strategies for reducing risks include more selective prescription of opioids and lower doses; use of prescription monitoring programs; avoidance of co-prescription with sedative hypnotics; and reformulations that make drugs more difficult to snort, smoke, or inject.

show abstract

“…The use of prescription opioids is a growing concern in North America [Furlan et al, ; MMWR ]. Prescription opioids have been associated with increased mortality and morbidity in the general [Calcaterra et al, ; Cerda et al, ] and Workers Compensation Board (WCB) populations [Franklin et al, ; Fulton‐Kehoe et al, ]. We have recently shown that a WCB claimant population is more likely to be prescribed higher doses of opioids and that these drugs are prescribed for longer durations than population based controls [Kraut et al, ].…”

Section: Introductionmentioning

confidence: 99%

A comparison of opioid use between WCB recipients and other Manitobans for knee, shoulder, back and carpal tunnel release procedures

Kraut

Raymond

Ekuma

et al. 2016

American J Industrial Med

View full text Add to dashboard Cite

BackgroundThis study's objectives were to evaluate whether WCB claimants with conditions requiring certain surgical procedures are more likely to be prescribed outpatient opioids than other Manitobans and whether those prescribed opioids are more likely to still be on opioid medications 6 months post procedure.MethodsWe compared 7,246 WCB claims for a number of surgical procedures to 65,032 similar procedures performed in other Manitobans. Logistic regression was used to explore the association between being a WCB claimant and being prescribed opioids, while controlling for type of surgical procedure and other potential confounders.ResultsWCB claimants were more likely than other Manitobans to be prescribed opioids (adjusted OR 1.38; 95%CI 1.30–1.47). Amongst those prescribed opioids, the odds of being still on opioids 6 months post‐procedure were not significantly elevated for WCB claimants (adjusted OR 1.09 95%CI 0.97–1.23).ConclusionsWCB claimants are prescribed opioids more often than non‐claimants for similar procedures. Am. J. Ind. Med. 59:257–263, 2016. © 2016 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.

show abstract

Opioid poisonings and opioid adverse effects in workers in Washington State

Abstract: Many poisonings and adverse effects occurred in patients without high dose or long-term opioid therapy, suggesting that opioid dosing and duration guidelines may not be sufficient to reduce morbidity related to prescription opioid use.

Cited by 44 publications

References 24 publications

High-Dose Opioid Prescribing and Opioid-Related Hospitalization: A Population-Based Study

High-Dose Opioid Prescribing and Opioid-Related Hospitalization: A Population-Based Study

Opioids for low back pain

A comparison of opioid use between WCB recipients and other Manitobans for knee, shoulder, back and carpal tunnel release procedures

Contact Info

Product

Resources

About