Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort.
METHODS
Prospective, population-based cohort study.


OBJECTIVE
To examine whether prescription of opioids within 6 weeks of low back injury is associated with work disability at 1 year.


BACKGROUND
Factors related to early medical treatment have been little investigated as possible risk factors for development of long-term work disability among workers with back injuries. We have previously shown that about 1 of 3 of workers receive an opioid prescription early after a low back injury, and a recent study suggested that such prescriptions may increase risk for subsequent disability.


METHODS
We analyzed detailed data reflecting paid bills for opioids prescribed within 6 weeks of the first medical visit for a back injury among 1843 workers with lost work-time claims. Additional baseline measures included an injury severity rating from medical records, and demographic, psychosocial, pain, function, smoking, and alcohol measures from a worker survey conducted 18 days (median) after receipt of the back injury claim. Computerized database records of work disability 1 year after claim submission were obtained for the primary outcome measure.


RESULTS
Nearly 14% (254 of 1843) of the sample were receiving work disability compensation at 1 year. More than one-third of the workers (630 of 1843) received an opioid prescription within 6 weeks, and 50.7% of these (319 of 630) were received at the first medical visit. After adjustment for pain, function, injury severity, and other baseline covariates, receipt of opioids for more than 7 days (odds ratio = 2.2; 95% confidence interval, 1.5-3.1) and receipt of more than 1 opioid prescription were associated significantly with work disability at 1 year.


CONCLUSIONS
Prescription of opioids for more than 7 days for workers with acute back injuries is a risk factor for long-term disability. Further research is needed to elucidate this association.
Franklin
Gary M
GM
Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA 98103, USA. meddir@u.washington.edu
Stover
Bert D
BD
Turner
Judith A
JA
Fulton-Kehoe
Deborah
D
Wickizer
Thomas M
TM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D019567:Back Injuries / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D010147:Pain Measurement; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014861:Washington / Q000453:epidemiology; D014942:Workers' Compensation / Q000706:statistics & numerical data
D000701:Analgesics, Opioid