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

Area of Science:

• Pain Management
• Public Health Policy
• Opioid Prescribing Trends

Background:

• Opioid prescribing for acute pain post-surgery increased misuse and overdose.
• Evaluated impact of guidelines on opioid prescribing for work-related injuries.

Purpose of the Study:

• Assess the effect of voluntary opioid prescribing guidelines and state pharmacy rules on postsurgical opioid prescribing.
• Analyze trends in long-duration and persistent opioid use after surgery for work-related injuries.

Main Methods:

• Utilized Washington State workers' compensation claims and prescription drug monitoring program data (2017-2020).
• Employed interrupted time-series analysis to evaluate changes in prescribing rates post-guideline implementation (2018-2019).
• Stratified analysis by surgical severity.

Main Results:

• Longer-duration opioid prescribing declined pre-policy (0.52%/month) and slowed post-policy (0.14%/month).
• The policy was associated with a modest slowing of the pre-existing decline in longer-duration opioid prescribing.
• Persistent opioid use (3-6 months post-surgery) remained stable at approximately 6.8%.

Conclusions:

• Washington State's postsurgical opioid prescribing guidelines and rules modestly slowed existing downward trends in longer-duration opioid prescribing.
• Voluntary guidelines showed limited impact, suggesting a need for stronger implementation strategies.
• Further interventions are necessary to reduce long-term postsurgical opioid prescribing in workers' compensation.