title: Early opioid prescription and risk of long-term opioid use among US workers with back and shoulder injuries: a retrospective cohort study.
abstract: The number of prescription opioid overdose deaths has increased dramatically in recent years and many prescribers are unsure how to balance treatment of pain with secondary prevention. Guidelines recommend low-severity injury patients not receive opioids early in the course of their care, but evidence supporting this guideline is limited. Data from 123 096 workers' compensation claims with back and shoulder injuries were analysed to evaluate this guideline. Back and shoulder injury claimants with early opioid use (≤1 month after injury) had 33% lower (95% CI 24% to 41% lower) odds and 29% higher (95% CI 6% to 58% higher) odds, respectively, of long-term opioid use (>3 months) than claimants with late opioid use, after adjusting for key covariates. Stratified analyses indicate that early opioid use does not appear to increase the risk of long-term use except in cases where no diagnosis or only the diagnosis of unspecified shoulder pain is given prior to prescription.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Heins
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Dorianne R
authors.initials: DR
authors.lastname: Feldman
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bodycombe
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Renan C
authors.initials: RC
authors.lastname: Castillo
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D019567:Back Injuries / Q000188:drug therapy*; D004185:Disability Evaluation; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D059352:Musculoskeletal Pain / Q000188:drug therapy*; D009784:Occupational Diseases / Q000188:drug therapy* / Q000191:economics; D009293:Opioid-Related Disorders / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D000070599:Shoulder Injuries / Q000188:drug therapy*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014942:Workers' Compensation / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid