Bending the prescription opioid dosing and mortality curves: impact of the Washington State opioid dosing guideline.
BACKGROUND
Opioid use and dosing for patients with chronic non-cancer pain have dramatically increased over the past decade, resulting in a national epidemic of mortality associated with unintentional overdose, and increased risk of disability among injured workers. We assessed changes in opioid dosing patterns and opioid-related mortality in the Washington State (WA) workers' compensation system following implementation of a specific WA opioid dosing guideline in April, 2007.


METHODS
Using detailed computerized billing data from WA workers' compensation, we report overall prevalence of opioid prescriptions, average morphine-equivalent dose (MED)/day, and proportion of workers on disability compensation receiving opioids and high-dose (≥120 mg/day MED) opioids over the past decade. We also report the trend of unintentional opioid deaths during the same time period.


RESULTS
Compared to before 2007, there has been a substantial decline in both the MED/day of long-acting DEA Schedule II opioids (by 27%) and the proportion of workers on doses ≥120 md/day MED (by 35%). There was a 50% decrease from 2009 to 2010 in the number of deaths.


CONCLUSIONS
The introduction in WA of an opioid dosing guideline appears to be associated temporally with a decline in the mean dose for long-acting opioids, percent of claimants receiving opioid doses ≥120 mg MED per day, and number of opioid-related deaths among injured workers.
Departments of Environmental and Occupational Health Sciences, Neurology, and Health Services, University of Washington School of Public Health, Seattle, WA 98109, USA. meddir@uw.edu
Gary M
GM
Franklin
Jaymie
J
Mai
Judith
J
Turner
Mark
M
Sullivan
Thomas
T
Wickizer
Deborah
D
Fulton-Kehoe
D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000506:poisoning*; D059350:Chronic Pain / Q000188:drug therapy; D062787:Drug Overdose / Q000401:mortality; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D009784:Occupational Diseases / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D014861:Washington; D014942:Workers' Compensation / Q000706:statistics & numerical data*
D000701:Analgesics, Opioid