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Prescription Dispensing Patterns Before and After a Workers’ Compensation Claim: An Historical Cohort Study of Workers With Low Back Pain Injuries in British Columbia

Carnide, Nancy, PhD; Hogg-Johnson, Sheilah, PhD; Furlan, Andrea D., MD, PhD; Côté, Pierre, DC, PhD; Koehoorn, Mieke, PhD

Journal of Occupational and Environmental Medicine: July 2018 - Volume 60 - Issue 7 - p 644–655
doi: 10.1097/JOM.0000000000001311

Objective: Compare prescription dispensing before and after a work-related low back injury.

Methods: Descriptive analyses were used to describe opioid, nonsteroidal anti-inflammatory drug (NSAID), and skeletal muscle relaxant (SMR) dispensing 1 year pre- and post-injury among 97,124 workers in British Columbia with new workers’ compensation low back claims from 1998 to 2009.

Results: Before injury, 19.7%, 21.2%, and 6.3% were dispensed opioids, NSAIDs, and SMRs, respectively, increasing to 39.0%, 50.2%, and 28.4% after. Median time to first post-injury prescription was less than a week. Dispensing was stable pre-injury, followed by a sharp increase within 8 weeks post-injury. Dispensing dropped thereafter, but remained elevated nearly a year post-injury, an increase attributable to less than 2% of claimants.

Conclusion: These drug classes are commonly dispensed, particularly shortly after injury and dispensing is of short duration for most, though a small subgroup receives prolonged courses.

Institute for Work & Health (Dr Carnide, Dr Hogg-Johnson, Dr Furlan, Dr Koehoorn); Canadian Memorial Chiropractic College (Dr Hogg-Johnson, Dr Côté); Dalla Lana School of Public Health, University of Toronto (Dr Hogg-Johnson, Dr Côté); Toronto Rehabilitation Institute, University Health Network (Dr Furlan); Department of Medicine, Faculty of Medicine, University of Toronto (Dr Furlan), Toronto; Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa (Dr Côté); and School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver (Dr Koehoorn), Canada.

Address correspondence to: Nancy Carnide, PhD, Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario M5G 2E9, Canada (

Disclosures: Andrea Furlan developed the Opioid Manager, a point-of-care tool that distils information from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. This app, available on iTunes for US$9.99, is owned by the University Health Network and all revenues are used to invest in the continued maintenance of the App itself. Mieke Koehoorn receives infrastructure funding from WorkSafeBC (the provincial workers’ compensation system in British Columbia, Canada) via a formal research agreement between the University of British Columbia and WorkSafeBC. The Institute for Work & Health receives infrastructure support from Ontario's Ministry of Labour.

All inferences, opinions, and conclusions drawn in this report are those of the authors, and do not reflect the opinions or policies of the Data Steward(s) or the Province of Ontario.

Conflicts of Interest: The authors express no conflict 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 © 2018 by the American College of Occupational and Environmental Medicine