Postsurgical Opioid Prescribing Among Injured Workers in Washington State: 2017-2020 Trends and Policy Effects

The widespread adoption of longer duration opioid prescribing for acute pain management following surgeries has coincided with concerning increases in misuse, dependence, and overdose. We evaluated the impact of voluntary opioid prescribing guidelines and concurrent state pharmacy rules on prescribing trends following surgeries for work-related injuries.

We analyzed claims data for surgical and postoperative care in the Washington State workers' compensation system, linked with prescription drug monitoring program data, from 2017 to 2020. We evaluated whether rates of long-duration opioid prescribing (> 14 opioid days) or persistent opioid prescribing (3-6 months post-surgery) decreased after the implementation of Washington State's postsurgical opioid prescribing guidelines and pharmacy rules (2018-2019), using an interrupted time-series analysis, stratified by surgical severity.

Prior to policy implementation, longer duration opioid prescribing was declining at a rate of 0.52 percentage points per month, on average, among all surgeries. Following the promulgation of guidelines and rules, this decline slowed significantly to 0.14 percentage points monthly (slope change: +0.38 percentage points; 95% CI: 0.11, 0.65). Similar decelerations were observed across surgical severity types. Persistent opioid use following surgery remained steady, around 6.8%.

Overall declines in longer duration opioid prescribing continued steadily after policy implementation, however, Washington State's postsurgical opioid prescribing guidelines and rules were associated with a modest slowing of pre-existing downward trends in longer duration opioid prescribing, counter to expectations. These findings suggest that voluntary guidelines may have had limited impact. More robust implementation strategies may be needed to further reduce longer duration postsurgical opioid prescribing patterns in a workers' compensation setting.