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Opioid and Benzodiazepine Use Before Injury Among Workers in Washington State, 2012 to 2015

Nkyekyer, Esi W., MD, MPH; Fulton-Kehoe, Deborah, PhD, MPH; Spector, June, MD, MPH; Franklin, Gary, MD, MPH

Journal of Occupational and Environmental Medicine: September 2018 - Volume 60 - Issue 9 - p 820–826
doi: 10.1097/JOM.0000000000001346

Objective: To characterize pre-injury prescription opioid and benzodiazepine use and its relationship with post-injury use and missed work among workers.

Methods: Three hundred thirteen thousand five hundred forty three Washington State Department of Labor and Industries workers’ compensation injury claims from 2012 to 2015 were linked with State Prescription Monitoring Program data. Pre-injury prevalence of opioid and benzodiazepine use were compared between compensable and non-compensable claims, and between workers with and without post-injury prescriptions, using the Pearson's chi-squared test.

Results: The prevalence of opioid or benzodiazepine use in the 90 days before injury was 8.6% and 2.9%, respectively. Workers with pre-injury opioid or benzodiazepine use were more likely to have compensable claims and be on opioids or benzodiazepines, respectively, after injury. Cases with chronic opioid use pre-injury nearly universally receive opioids post-injury.

Conclusions: Pre-injury opioid and benzodiazepine use may increase the risk of disability after work-related injury.

Division of General Internal Medicine, Occupational and Environmental Medicine (Dr Nkyekyer, Dr Spector); Department of Environmental and Occupational Health Sciences (Dr Fulton-Kehoe, Dr Spector); Departments of Environmental and Occupational Health Sciences and Health Services (Dr Franklin), School of Public Health; and Department of Neurology, School of Medicine (Dr Franklin), University of Washington, Seattle, Washington.

Address correspondence to: Esi W. Nkyekyer, MD, MPH, Division of General Internal Medicine, Occupational and Environmental Medicine, University of Washington, 325 9th Avenue, Box 359739, Seattle, WA 98104 (

Funding: This work was supported by the CDC's National Institute for Occupational Safety and Health (Grant number 5T42OH008433–13), and the Washington State Medical Aid and Accident Fund appropriation to the University of Washington Department of Environmental and Occupational Health Sciences.

Conflicts of Interest: None declared.

Copyright © 2018 by the American College of Occupational and Environmental Medicine