Injured staff on high-risk opioids funded by workers’ comp

Thousands of employees being treated for back and neck injuries are receiving high-risk opioid ­prescriptions funded by workers’ compensation systems.  

Workers suffering back and neck injuries are being prescribed high-risk opioids.

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Thousands of employees being treated for back and neck injuries are receiving high-risk opioid ­prescriptions funded by workers’ compensation systems, Monash University-led research has ­revealed.

Among those prescribed ­opioids in the first three months, two out of three workers had early high-risk opioid prescriptions, and nearly one in four continued using opioids after a year.

The researchers investigated opioid prescriptions for injured employees funded by the Victorian workers’ compensation system, and for the first time measured the number with early high-risk prescribing patterns.

Senior author and Healthy Working Lives Research Group director Alex Collie said the results highlighted the extent of two ­potentially very harmful patterns among workers with common workplace injuries and compensation claims – early high-risk ­opioid prescribing and long-term opioid use.

“More than 120,000 Australians have workers’ compensation claims involving more than a week off work every year, and many of these claims are for back and neck injuries,” Professor Collie said.

“If the patterns we observe in Victoria also occur in other states and territories, then potentially thousands of workers are receiving high-risk opioid prescriptions funded by our workers’ compensation systems.

“This study highlights the need for stronger monitoring of prescription patterns in our workers’ compensation systems, and the need for stronger approaches to prevent potentially harmful prescription opioid use.”

Researchers analysed data from 30,590 employees with back and neck injuries from 2010 to 2019, who had time off work due to their injury and made a workers’ compensation claim. Of these, 6278, about 20.5 per cent, were prescribed opioids in the first three months of their claim.

Professor Collie said it was generally recommended to avoid ­opioids if possible and use other pain-relief methods first. If opioids are prescribed, they should be used for a short time and in low doses.

First author Yonas Tefera, from Monash University’s School of Public Health and Preventive Medicine Healthy Working Lives Research Group, said the team ­analysed detailed data on the type, volume and timing of opioid prescriptions paid for by the workers’ compensation system.

“Prescribing was considered high-risk if there was a large volume prescribed within the first three months, if long-acting ­opioids were prescribed early, or if other high-risk medicines were prescribed at the same time as ­opioids,” he said.

“We also found that early high-risk prescribing doubled the chances of long-term opioid use. Previous studies show that injured workers who use opioids early or for a long time tend to have more time off work and worse health outcomes.”

Published in the peer-reviewed journal CNS Drugs, the study found workers in rural and economically disadvantaged areas were more likely to receive early high-risk opioid prescriptions and also to have long-term use.

In a study published last year in the Journal of Occupational and Environmental Medicine, the ­Monash research team found that most workers’ compensation regulators in Australia do not routinely capture data on prescription medicines.

“Victoria is one of only two states in the country where this sort of analysis is possible, because the other state workers’ compensation systems aren’t collecting detailed information on the medicines they are paying for,” Professor Collie said. South Australia is the second state.

The researchers said their findings should be a cause of concern due to the significant prevalence of high-risk opioid prescribing and the growing concern of opioid-related harms and unintended consequences from non-judicious use of opioid medicines. “Prescribers should pay attention to and balance pain management with the apparent higher risks of opioid use in injured workers,” their research concluded.

“Patient involvement and education on risks of early and long-term opioid use are also essential. Workers’ compensation scheme funders and regulators should closely monitor funded prescription medicine patterns to limit ­potentially harmful prescribing trends in injured workers.”