Institutional members access full text with Ovid®

Share this article on:

Impact of a Graduated Approach on Opioid Initiation and Loss of Earnings Following Workplace Injury: A time series analysis

Gomes, Tara MHSc, PhD; Duesburry, June MScN, MBA; Theriault, Marc-Erick MSc; Bain, Donna PhD; Singh, Samantha BSc; Martins, Diana MSc; Juurlink, David MD PhD
Journal of Occupational and Environmental Medicine: Post Acceptance: October 03, 2017
doi: 10.1097/JOM.0000000000001187
Original Article: PDF Only


To explore the impact of the Ontario Workplace Safety & Insurance Board's (WSIB's) graduated approach to opioid management on opioid prescribing and disability claim duration.


We studied patterns of opioid use and disability claim duration among Ontarians who received benefits through the WSIB between 2002 and 2013. We used interventional time series analysis to assess the impact of the WSIB graduated formulary on these trends.


After the introduction of the graduated formulary, initiation of short- and long-acting opioids fell significantly (p-value < 0.0001). We also observed a shift toward the use of short-acting opioids alone (p < 0.0001). Although disability claim duration declined, this could not be ascribed to the intervention (p = 0.18).


A graduated opioid formulary may be an effective tool for providers to promote more appropriate opioid prescribing.

Address correspondence to: Tara Gomes, MHSc, PhD, 30 Bond St., Toronto, Ontario (

FUNDING SOURCES: This study was funded by a grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC) Health System Research Fund and supported by the Institute for Clinical Evaluative Sciences (ICES). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the Ontario MOHLTC or ICES is intended or should be inferred.

COMPETING INTERESTS: Marc-Erick Theriault, June Duesburry, and Donna Bain were all employees of WSIB during the conduct of this study. Tara Gomes and David Juurlink have received grant funding from the Ontario Ministry of Health and Long-Term Care.

The authors report no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Copyright © 2017 by the American College of Occupational and Environmental Medicine