Opioid dosing trends and mortality in Washington State workers' compensation, 1996-2002.
BACKGROUND
The use of opioids for chronic non-cancer pain has increased in the United States since state laws were relaxed in the late 1990s. These policy changes occurred despite scanty scientific evidence that chronic use of opioids was safe and effective.


METHODS
We examined opiate prescriptions and dosing patterns (from computerized databases, 1996 to 2002), and accidental poisoning deaths attributable to opioid use (from death certificates, 1995 to 2002), in the Washington State workers' compensation system.


RESULTS
Opioid prescriptions increased only modestly between 1996 and 2002. However, prescriptions for the most potent opioids (Schedule II), as a percentage of all scheduled opioid prescriptions (II, III, and IV), increased from 19.3% in 1996 to 37.2% in 2002. Among long-acting opioids, the average daily morphine equivalent dose increased by 50%, to 132 mg/day. Thirty-two deaths were definitely or probably related to accidental overdose of opioids. The majority of deaths involved men (84%) and smokers (69%).


CONCLUSIONS
The reasons for escalating doses of the most potent opioids are unknown, but it is possible that tolerance or opioid-induced abnormal pain sensitivity may be occurring in some workers who use opioids for chronic pain. Opioid-related deaths in this population may be preventable through use of prudent guidelines regarding opioid use for chronic pain.
Franklin
Gary M
GM
Department of Occupational and Environmental Health Sciences, Occupational Epidemiology and Health Outcomes Program, University of Washington School of Public Health and Community Medicine, Seattle, Washington 98103, USA. meddir@u.washington.edu
Mai
Jaymie
J
Wickizer
Thomas
T
Turner
Judith A
JA
Fulton-Kehoe
Deborah
D
Grant
Linda
L
D000059:Accidents / Q000401:mortality; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000145:classification / Q000191:economics / Q000506:poisoning*; D002908:Chronic Disease; D003644:Death Certificates; D062787:Drug Overdose / Q000401:mortality*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000150:complications* / Q000191:economics; D010146:Pain / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D011640:Public Policy; D014861:Washington / Q000453:epidemiology; D014942:Workers' Compensation / Q000706:statistics & numerical data*
D000701:Analgesics, Opioid