Results Summary

What was the research about?

A type of medicines called opioids can help ease acute pain caused by an injury. But long-term opioid use can lead to addiction, overdose, or death. One way to prevent these problems is to reduce unsafe prescribing. Unsafe prescribing includes taking high-dose opioids or taking opioids for longer than 60 days.

In this study, the research team compared a workers’ compensation program for injured workers in Washington State with a program in Ohio:

  • Washington State. This program used prior authorization. Insurance doesn’t pay for opioids unless doctors get approval first. Then doctors must agree to follow safe prescribing practices.
  • Ohio. This program used retrospective review. A nurse reviews patients’ health records. If they find signs of unsafe prescribing, they mail a letter to the doctor asking them to explain. If the doctor can’t explain, then the health insurer stops paying for the opioids.

The research team looked at how well the programs worked to reduce unsafe opioid prescribing.

What were the results?

After one year, the two programs didn’t differ in unsafe opioid prescribing. Compared with patients in Ohio, patients in Washington were:

  • More likely to receive time-loss benefits, which provide patients with wages while they can’t work
  • More satisfied with the care they received for their pain

The two programs didn’t differ in patient reports of:

  • Pain
  • Symptoms of anxiety or depression
  • Activity levels
  • Income
  • Use of opioids
  • Quality of life

What did the research team do?

The research team looked at workers’ compensation claims for patients with opioid prescriptions. The data included 4,632 patients in Washington and 779 patients in Ohio. Of these, 75 percent were men and 23 percent were 35–44 years old.

The research team also surveyed 1,965 workers in Washington and 319 workers in Ohio. These workers had received workers’ compensation and had an opioid prescription. They completed surveys one year after their injury. Surveys asked about workers’ health and their ability to work after they received opioids.

Patients with chronic pain and pharmacy managers provided input during the study.

What were the limits of the study?

The research team may not have had data on all the opioid prescriptions each patient received. Results may have been different if the team had had data on all prescriptions. The study looked at two states’ programs for workers with injuries. Results may differ in other states.

Future research could use more data sources on opioid prescriptions. Studies could also look at other states’ workers’ compensation programs to reduce unsafe opioid prescribing.

How can people use the results?

Workers’ compensation policy leaders can use these results when considering ways to promote safe opioid prescribing for workplace injuries.

PCORI identified unsafe opioid prescribing as an important research topic. Patients, clinicians, and others wanted to learn: How can primary care providers work with patients with noncancer pain to plan safe treatment and provide adequate pain management? To help answer this question, PCORI launched an initiative in 2016 on Strategies to Prevent Unsafe Opioid Prescribing in Primary Care among Patients with Acute or Chronic Noncancer Pain. The initiative funded this research project and others.

Final Research Report

This project's final research report is expected to be available by August 2024.

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Conflict of Interest Disclosures

Project Information

Gary Franklin, MD, MPH
University of Washington
Comparative Effectiveness of Two State Payer Strategies to Prevent Unsafe Opioid Prescribing

Key Dates

August 2018
July 2023

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: November 20, 2023