Stemming the Tide of Prescription Opioid-Related Morbidity Among Injured Workers

Details

• Personal Author:
  Sears JM
• Description:
  High-risk opioid prescribing practices in workers' compensation settings are associated with excess opioid-related morbidity, longer work disability and higher workers' compensation costs. Accurate surveillance of opioid morbidity rates and demographic patterns is necessary for effective prevention planning, intervention, and evaluation. This study characterized the burden of prescription opioid-related hospitalizations among injured workers. Hospital discharge data for eight states (Arizona, Colorado, Michigan, New Jersey, New York, South Carolina, Utah, Washington) were obtained from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Injured workers were identified using payer (workers' compensation) and external cause of injury codes. There were about six times as many adverse effect hospitalizations as overdose hospitalizations, on average. State-based five-year (2010-2014) average annual rates of prescription opioid overdose/adverse effect hospitalizations among injured workers ranged from 0.3 to 1.2 events per 100,000 employed workers. Among inpatients aged 15 to 64 (age range was restricted to enhance comparability across groups), rates for injured workers ranged from 0.3 to 1.1 events per 100,000 employed workers, while rates for all inpatients ranged from 39.6 to 78.2 events per 100,000 civilian population. Estimated five-year average annual rates for men were higher than those for women. Among those hospitalized with prescription opioid overdose/adverse effects, injured workers were more likely than other inpatients to have a low back disorder diagnosis, and less likely to have a diagnosis of opioid dependence/abuse or cancer, or a fatal outcome. In the four states with estimated rates for every age category, there was a monotonic rate increase with age. Rates for injured workers aged 65 and older were two to six times the overall injured-worker rates, ranging from 1.9 to 4.4 per 100,000 employed workers. These markedly higher rates among older workers suggest that clinicians prescribing opioids to older workers should carefully assess potential risk related to physiologic changes associated with aging, as well as presence of chronic conditions, social and mental health factors, and other prescription medications. Several important barriers to accurate opioid morbidity surveillance among injured workers were identified, centering around the small number of prescription opioid-related events billed to workers' compensation. Case capture of prescription opioid overdose/adverse effects increased by about 3% when using injured worker E-codes in addition to workers' compensation as payer. First-listed diagnoses/E-codes captured about 60% of the prescription overdose/adverse effect cases that were captured when using all-listed diagnoses/E-codes. The extent to which work-related prescription opioid morbidity is not covered by workers' compensation is unknown. Among injured workers who were identified using only E-codes, workers' compensation was the primary expected payer for 67% of all hospitalizations, versus 59% when restricted to prescription opioid overdose/adverse effect hospitalizations, suggesting that workers' compensation may be somewhat less likely to cover opioid morbidity-related hospitalizations compared to other hospitalizations. In sum, this research bolsters the sparse epidemiological evidence regarding opioid-related morbidity among injured workers. Additional research is needed to further assess the degree to which workers' compensation as payer adequately identifies work-related opioid morbidity for research and surveillance purposes. [Description provided by NIOSH]
• Subjects:
  Demography Epidemiology Morbidity Occupational Health Safety
• Keywords:
  Costs Demographic Characteristics Electronic Health Records Medical Records Morbidity Rates Prescription Drugs Surveillance Workers Compensation
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  Arizona ; Colorado ; Michigan ; New Jersey ; New York ; OSHA Region 10 ; OSHA Region 2 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 8 ; OSHA Region 9 ; South Carolina ; Utah ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-33
• NIOSHTIC Number:
  nn:20064407
• NTIS Accession Number:
  PB2022-100423
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R03-OH-010943, 2021 Sep; :1-33
• Contact Point Address:
  Jeanne M. Sears, Principal Investigator, Department of Health Systems and Population Health, University of Washington Box 357660 Seattle, WA 98195
• Email:
  jeannes@uw.edu
• Federal Fiscal Year:
  2021
• Performing Organization:
  University of Washington, Seattle
• Peer Reviewed:
  False
• Start Date:
  20180901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20200831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d2893f58803155fe1893d80f2ff355b464d9b8e037975c3c5d80848ef3b9e0e48a485df2854b7586be69236c7b1473c9a145e324bae053e6e9b8d5de57d3db11
• Download URL:
  https://stacks.cdc.gov/view/cdc/219094/cdc_219094_DS1.pdf
• File Type:
  [PDF - 403.10 KB ]