Dose Escalations Among Workers' Compensation Claimants Using Opioid Medications-An 8 Year Postinjury Follow up Study

Area of Science:

• Pain Management
• Occupational Health
• Pharmacology

Background:

• Opioid use in managing workplace injuries is common.
• Understanding long-term opioid dose escalation is crucial for patient safety and healthcare costs.
• Previous studies have not fully elucidated dose escalation trends based on initial opioid utilization.

Purpose of the Study:

• To investigate the trend of morphine equivalent dose (MED)/day escalation after initial opioid utilization in lost time claims.
• To analyze opioid dose escalation patterns across different initial daily MED categories.

Main Methods:

• Analysis of 25,108 lost time claims from 1998-2007, followed for 8 years post-injury.
• Stratification of claims based on initial MED/day at 3 months post-injury into four groups.
• Determination of the annual rate of opioid dose escalation (MED/year) for each initial dose category.

Main Results:

• Opioid MED/day demonstrated a consistent linear escalation pattern across all initial dose groups.
• The average annual increase in MED/day was 6.28 MED/year (P < 0.01).
• Escalation rates were similar across initial MED/day categories, ranging from 5.38 to 7.76 MED annually (P ≥ 0.05).

Conclusions:

• Opioid dose escalation follows a linear trajectory irrespective of the initial prescribed morphine equivalent dose (MED)/day.
• This suggests a potential for sustained opioid dose increases in injured workers, regardless of their starting dose.
• Findings underscore the importance of monitoring opioid therapy and exploring interventions to mitigate long-term dose escalation.