Prescription opioid overdose and adverse effect hospitalisations among injured workers in eight states (2010–2014)

Abstract

ObjectiveHigh-risk opioid prescribing practices in workers’ compensation (WC) settings are associated with excess opioid-related morbidity, longer work disability and higher costs. This study characterises the burden of prescription opioid-related hospitalisations among injured workers.MethodsHospital discharge data for eight states (Arizona, Colorado, Michigan, New Jersey, New York, South Carolina, Utah and Washington) were obtained from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We calculated 5-year (2010–2014) average annual rates of prescription opioid overdose/adverse effect (AE) hospitalisations. Injured workers were identified using payer (WC) and external cause codes.ResultsState-level average annual prescription opioid overdose/AE hospitalisation rates ranged from 0.3 to 1.2 per 100 000 employed workers. Rates for workers aged ≥65 years old were two to six times the overall rates. Among those hospitalised with prescription opioid overdose/AEs, injured workers were more likely than other inpatients to have a low back disorder diagnosis, and less likely to have an opioid dependence/abuse or cancer diagnosis, or a fatal outcome. Averaged across states, WC was the primary expected payer for <1% of prescription opioid overdose/AE hospitalisations vs 6% of injury hospitalisations.ConclusionsPopulation-based estimates of prescription opioid morbidity are almost nonexistent for injured workers; this study begins to fill that gap. Rates for injured workers increased markedly with age but were low relative to inpatients overall. Research is needed to assess whether WC as payer adequately identifies work-related opioid morbidity for surveillance purposes, and to further quantify the burden of prescription opioid-related morbidity.

Short‐acting opioid prescriptions and Workers' Compensation using the National Ambulatory Medical Care Survey

“…There is limited research on how opioid prescribing in this population translates to potential morbidity and mortality. [15][16][17][18][19][20] A study from the Washington Workers' Compensation Disability Risk Identification Study Cohort found an association between workers with acute back injuries who were prescribed opioids for 7 or more days and long-term disability. 15 This is echoed in a 2017 systematic review evaluating musculoskeletal disorders, although the authors also concluded that additional high-quality research is needed to validate their results.…”

“…17 A recent study from the Ohio Bureau of WC raised concern for an increased risk of death in those with higher maximum claim-prescribed daily morphine-equivalent doses of opioids; however, another study found that WC was infrequently the payer for the prescription causing opioid overdose or adverse event hospitalizations. 18,19 Outside of the WC system, a study from Utah showed that of opioid-related deaths 57% had one or more previous workrelated injuries. 20 Additional research is needed to understand opioid prescribing trends and factors that may be associated with increased opioid prescriptions.…”

“…It is important to evaluate opioid prescribing in the WC population, especially given the musculoskeletal injuries that are treated and the concern for morbidity and mortality associated with opioid use. There is limited research on how opioid prescribing in this population translates to potential morbidity and mortality 15–20 . A study from the Washington Workers' Compensation Disability Risk Identification Study Cohort found an association between workers with acute back injuries who were prescribed opioids for 7 or more days and long‐term disability 15 .…”

“…Another systematic review found high‐risk populations, including WC patients, had a higher rate of prolonged opioid use following a musculoskeletal injury compared with other populations 17 . A recent study from the Ohio Bureau of WC raised concern for an increased risk of death in those with higher maximum claim‐prescribed daily morphine‐equivalent doses of opioids; however, another study found that WC was infrequently the payer for the prescription causing opioid overdose or adverse event hospitalizations 18,19 . Outside of the WC system, a study from Utah showed that of opioid‐related deaths 57% had one or more previous work‐related injuries 20 .…”