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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 N. MD, PhD

Journal of Occupational and Environmental Medicine: December 2017 - Volume 59 - Issue 12 - p 1197–1201
doi: 10.1097/JOM.0000000000001187
Original Articles

Objective: The aim of this study was to explore the impact of the Ontario Workplace Safety and Insurance Board's (WSIB's) graduated approach to opioid management on opioid prescribing and disability claim duration.

Methods: 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.

Results: After the introduction of the graduated formulary, initiation of short- and long-acting opioids fell significantly (P < 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).

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

Supplemental Digital Content is available in the text

The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (Drs Juurlink, Gomes, Ms Singh, Ms Martins); Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada (Dr Gomes); Workplace Safety and Insurance Board, Toronto, Ontario, Canada (Mr Theriault, Mr Duesburry, Dr Bain); Institute for Health Policy, Management, and Evaluation at the University of Toronto, Toronto, Ontario, Canada (Drs Juurlink, Gomes); and the Leslie Dan Faculty of Pharmacy at the University of Toronto, Toronto, Ontario, Canada (Dr Gomes).

Address correspondence to: Tara Gomes, MHSc, PhD, 30 Bond St., Toronto, ON, M5B 1W8, Canada (

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.

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 (

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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