To compare the effectiveness of two opioid prescribing programs in reducing unsafe opioid prescribing and improving patient-reported outcomes among patients who were injured on the job and receiving workers’ compensation
|Observational: cohort study
Cohort study: workers’ compensation claims for 4,632 adults from Washington State and 779 adults from Ohio with a new claim and at least one opioid prescription for acute pain paid for by workers’ compensation
Survey: 1,965 adults from Washington State and 319 adults from Ohio who received opioid prescriptions shortly after injury
- Prior authorization for opioid prescriptions
- Retrospective review of opioid prescriptions
Primary: unsafe opioid prescribing, which was defined as greater than 7 days’ supply of opioids for subacute use, or for chronic use, at least 60 days’ supply of opioids, concurrent use of sedatives or hypnotics with opioids, and high dose opioids
Secondary: patient-reported decrease in pain, anxiety, or depression; improvement in activity limitation; not working for pay; receiving time-loss benefits; earning less than before injury; self-reported chronic opioid use; quality of life; satisfaction with overall treatment; satisfaction with pain treatment
|1-year follow-up for primary outcome
This prospective observational cohort study compared the effectiveness of two opioid prescribing programs in Washington and Ohio in reducing unsafe opioid prescribing and improving patient-reported outcomes. The programs were:
- Prior authorization. Washington requires prescribers to seek approval for opioid prescriptions beyond six weeks after injury. Prescribers must submit documentation showing that they followed opioid-prescribing best practices and that taking opioids resulted in clinically meaningful pain reduction for the patient. Washington workers' compensation insurance only pays for opioid prescriptions with prior authorization.
- Retrospective review. Six weeks after a patient's injury, Ohio authorizes a nurse review of opioid prescription claims to look for documentation that prescribers followed opioid-prescribing best practices. If missing, Ohio workers' compensation mails up to three requests for prescribers to provide documentation. If prescribers do not provide documentation, workers' compensation insurance stops paying for opioid prescriptions.
Researchers reviewed workers' compensation claims data for 4,632 patients with a new injury from Washington and 779 patients from Ohio. Among patients in Washington, 25% were female; the average age was 41.8 years. Among patients in Ohio, 25% were female and the average age was 44.7 years.
For patient-reported outcomes, at one year, researchers surveyed 1,965 Washington patients and 319 Ohio patients receiving at least one opioid prescription within six weeks of their injury. The survey asked about pain, anxiety, depression, activity limitations, and whether the patient was working for pay or receiving time-loss benefits, which are wage replacement payments for people who cannot work. The survey also asked about self-reported opioid use, quality of life, satisfaction with overall treatment, and if patients were earning less than before their injury.
Patients with chronic pain, a patient with a work-related injury, and workers' compensation insurance or pharmacy managers provided input throughout the study.
After one year, the two programs did not differ significantly in unsafe opioid prescribing. Compared with patients in Ohio, patients in Washington were more likely to receive time-loss benefits (odds ratio [OR]=1.97; 95% confidence interval [CI]: 1.12, 3.47) and were more satisfied with their pain treatment (β=0.22; 95% CI: 0.05, 0.38). The two programs did not differ significantly in other patient-reported outcomes.
Because workers’ compensation claims only include opioid prescriptions paid through workers’ compensation, opioid prescriptions from other sources were not included in the analyses. The study only looked at two state-funded workers’ compensation systems. Results may differ for other workers’ compensation systems.
Conclusions and Relevance
The study did not find significant differences in unsafe opioid prescribing when comparing prior authorization with retrospective reviews. Compared with patients in Ohio, patients in Washington reported more time-loss benefits and more satisfaction with their care.
Future Research Needs
Future research could use other data sources like prescription drug monitoring programs to obtain more complete opioid prescribing information or examine other states’ workers’ compensation programs to reduce unsafe opioid prescribing.