Opioid use among injured workers: pain and the return-to-work experience

In this cross-sectional analysis, we explored how return-to-work (RTW) experiences and postinjury pain are associated with opioid use after a workplace injury/illness.

Workers with accepted lost-time claims, compensated by the workers' compensation board in Ontario, Canada were interviewed by telephone 18 months following a work-related physical injury/illness. Participants were asked about their past-year opioid use, current pain, RTW timing and workplace accommodations. Separate logistic regression analyses were conducted to estimate the association between two independent variables and opioid use: one combining the presence of pain with workplace accommodation and a second combining the presence of pain with RTW timing, adjusted for sociodemographic, work, injury and health covariates.

Of 1793 participants included in the analysis, 35.6% used opioids more than once in the past 12 months. Compared with those who did not return to work too soon and had no/mild pain, odds of opioid use were higher among those with severe pain, both those who returned too soon (OR 2.90, 95% CI 2.11 to 3.99) and those who did not return too soon (OR 3.01, 95% CI 2.16 to 4.19). Compared with those who had an offer of accommodation and no/mild pain, workers with severe pain and an accommodation offer (OR 2.78, 95% CI 2.16 to 3.57) or without an offer (OR 2.69, 95% CI 1.90 to 3.81) had increased odds of reporting use of opioids.

Findings suggest pain is the main factor associated with opioid use after a work-related injury, irrespective of RTW experiences. However, due to the limitations of this exploratory analysis, longitudinal research examining this issue is warranted.