SAT0574 RISK FACTORS ASSOCIATED WITH OPIOID USE AMONG WORKER’S COMPENSATION: A LITERATURE REVIEW
Authors: M. Agalioitis, A. Sran
Journal: Annals of the Rheumatic Diseases (2020)

Background: To increase recovery and return to work after an occupational accident or injury, a worker’s compensation claim provides individualised management plan involving multiple kinds of treatment. These plans can consist of the prescription of opioids to reduce inflammation, provide pain relief and increase functionality within a short period of time to aid return to work. Recently, there have been growing concerns about the misuse of opioids in managing pain symptoms by both the insurance industry and the general community. Studies from North America have indicated the prescription and management of opioid consumption among workers compensation claimants can cause more harm to functionality and reduce recovery to return to work, often leading to misuse, dependency or overdosing (Dembe, Wickizer, Sieck, Partridge &amp; Balchick (2012)]. Objectives: The aims of this abstract are to provide a comprehensive literature review of the studies that have examined: 1) the prevalence of opioid use among worker compensations claimants and, 2) identify predictors of long-term opioid use among the workers compensation claimants. Methods: A search strategy, with terms associated with “worker compensation”, “opioids” “prevalence” and/or “risk factors” were used to search through relevant databases such as CINAHL, Cochrane, Embase, MEDLINE, PsycINFO, Scopus and Web of Science from database inception to January 2020. Duplicates were excluded. Two researchers retrieved, screened for eligibility and reviewed the results accordingly using a staged approach. Systematic review registration number PROSPERO registry number: CRD42013004137. Results: The search yielded 2857 records. After the initial screening, 125 full-text articles were assessed by two independent reviewers. The inclusion criteria were met by nine studies1-9. All studies conducted retrospective cohort studies using workers compensation claimant’s data, ranging from 54,931, to 100,357 reports, either over a short 12-month period to over 11 years, with no reporting of response rate or recruitment rates. All studies examined the association of being exposure to opioids from the date of the workers injury(7), ranging from 30 to 730 days or from 0 days to 4 or more years1 4-9. Carnide et al (2018)2 was the only study to investigate opioid exposure before and after injury as a predictor of future long term use. Among those who examined work-opioid related factors (4) found workers compensation reports with work disability for more than 14 days where more likely to become a long term opioid uses (OR: 2.17 [95% CI:1.52–3.10])1. Kraut et al7 on the other hand, found being a worker’s compensation claimant increased the risk of being prescribed ≥ 120 morphine equivalents (ME) per day (ME/D) (OR: 2.06 [95% CI: 1.58 - 2.69]), than those who were not in workers compensation program. Another study found, initial days of supply of opioids from 5 to 20 or more days was strongly associated with long term use of opioids (OR: 28.94 [95%CI, 23.44-35.72])5. While a study by Heins et al (2015)6 examined receiving opioids within the first month, people with back injuries were less likely to become a long-term opioid user (OR: 0.67 [95% CI: 0.59 – 0.76]), while those with shoulder injury were at risk (OR: 1.29 [95% CI: 1.06 – 1.58]). Conclusion: There are a number of reliable prevalence studies among workers compensation settings indicating opioid use is below 20 percent however, there remains inconsistencies when examining predictors of long term or persistent opioid use. After reviewing the literature, a validity of studies will be conducted and graded by two authors independently using a standardised checklist to complete a systematic review for publication which will assist with managing opioid use among work compensation claimants and managers. Disclosure of Interests: None declared