Elsevier

The Journal of Pain

Volume 14, Issue 12, December 2013, Pages 1620-1628
The Journal of Pain

Original Report
Changes in Opioid Prescribing for Washington Workers' Compensation Claimants After Implementation of an Opioid Dosing Guideline for Chronic Noncancer Pain: 2004 to 2010

https://doi.org/10.1016/j.jpain.2013.08.001Get rights and content
Under an Elsevier user license
open archive

Abstract

An opioid overdose epidemic emerged in the United States following increased opioid prescribing for chronic noncancer pain. In 2007, Washington State agencies implemented an opioid dosing guideline on safe prescribing for chronic noncancer pain. The objective of this population-based observational study was to evaluate opioid use and dosing before and after guideline implementation. We identified 161,283 workers aged 18 to 64 years with ≥1 opioid prescriptions in Washington Workers' Compensation, April 1, 2004, to December 31, 2010. Prevalence and incidence rates of opioid use were assessed. We compared pre- and postguideline chronic and high-dose use (≥120 mg/d) among incident users. The mean monthly prevalence of opioid use declined by 25.6% between 2004 (14.4%) and 2010 (10.7%). Fewer incident users went on to chronic opioid therapy in the postguideline period (4.7%; 95% confidence interval [CI], 4.5–5.0%) than in the preguideline period (6.3%; 95% CI, 6.1–6.6%). Compared with preguideline incident users, postguideline incident users were 35% less likely to receive high doses (adjusted odds ratio = .65; 95% CI, .59–.71). Although the extent to which decreases were due to the guidelines is uncertain, to our knowledge, this is the first report of significant decreases in chronic and high-dose prescription opioid use among incident users.

Perspective

Evidence-based strategies for opioid risk management are needed to help abate the epidemic of opioid-related morbidity and mortality. The study findings suggest that opioid dosing guidelines that specify a “yellow flag” dosing threshold may be a useful tool in preventing escalation of doses into ranges associated with increased mortality risk.

Key words

Opioids
dosing
trends
guideline
chronic pain

Cited by (0)

Study Sponsor and Support: Centers for Disease Control and Prevention, Grant number: 5R21CE001850-01, 09/01/2010 – 08/31/2012.

The Centers for Disease Control and Prevention had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

None of the authors have any financial or nonfinancial conflicts in regard to this work.