Opioid dependence in 15 patients after a work injury

To document aspects of the management of 15 patients with workers' compensation injuries which led to opioid dependence and suggest preventive strategies.

Details of general practitioner and deputising service visits for a 38-week period, 1 May 1991 - 22 January 1992, were obtained from WorkCover case files and general practitioners' patient records, and claims for reimbursement for afterhours home visits (Item 97) were obtained from the Health Insurance Commission (HIC) for the years 1991, 1992 and 1993.

Fourteen of the patients had a lumbosacral injury. A total of 2489 deputising service visits were provided on 3227 days (0.77/day). A statistically significant 20% higher visit rate occurred on Sundays and public holidays compared with the rate for the rest of the week. Deputising service practitioners provided 4.7 times as many services as general practitioners. In 1299 visits to 12 of these patients, parenteral drugs administered included 108 385 mg pethidine, 2680 mg morphine, and 20 400 mg promethazine. All 15 patients were independently assessed as having features indicating opioid dependence. In only one patient was there evidence of opioid dependence before injury. An alternative management plan not requiring deputising service visits was instituted early in 1992. The number of claims from the HIC for afterhours visits to these 15 patients rose from 125 in 1991 to 630 in 1992, while 409 were provided in 1993.

Appropriate strategies, such as restricting the ability of deputising services to bill directly for the services they provide, and a sharing of information between the HIC and other statutory authorities, should prevent a similar occurrence in the future.