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Natural History of Opioid Dosage Escalation Post-Injury: A Cohort Study of Injured Workers in the State of Louisiana

Tao, Xuguang (Grant) MD, PhD; Lavin, Robert A. MD; Yuspeh, Larry BA; Bernacki, Edward J. MD, MPH

Journal of Occupational and Environmental Medicine: April 2012 - Volume 54 - Issue 4 - p 439–444
doi: 10.1097/JOM.0b013e3182451e39
Original Articles

Objective: To determine the relationship between opioid dosage and claim duration.

Methods: Closure rates and morphine-equivalent dose were analyzed over a 7-year period for 11,394 lost-time claims filed with the Louisiana Workers' Compensation Corporation.

Results: The percentage of claims in which opioids were ever prescribed increased from 43.3% in year 1 to 80.8% in year 7 post-injury. The percentage of claims in which individuals were prescribed long-acting (LA) opioids increased from 5.2% to 29.6%, and the percentage of claims in which individuals were prescribed only short-acting (SA) opioids increased from 38.1% to 51.2%. Morphine-equivalent dose increased from 10.0 mg/day (year 1) to 143.2 mg/day (year 7) for claims in which individuals were prescribed LA opioids. The average claim duration for claims in which individuals were prescribed no opioids, only SA opioids, and LA opioids was 415, 930, and 2025 days, respectively.

Conclusion: Opioid dosage escalates as claims mature.

From the Division of Occupational and Environmental Medicine (Drs Tao and Bernacki), Department of Medicine, Johns Hopkins University School of Medicine, and Department of Neurology (Dr Lavin), University of Maryland School of Medicine, Baltimore, Md; and Development and Strategy Management (Mr Larry), Louisiana Workers' Compensation Corporation, Baton Rouge, La.

Address correspondence to: Edward J. Bernacki, MD, MPH, Director of Occupational and Environmental Medicine, Johns Hopkins University, School of Medicine, 600 N Wolfe St, Billings Administration 129, Baltimore, MD 21287 (bernacki@jhmi.edu).

Partial funding for the research was provided by the Louisiana Workers' Compensation Corporation. The authors declare no conflict of interest.

©2012The American College of Occupational and Environmental Medicine