Over two-thirds of opioid prescriptions provided through workers’ compensation schemes in Victoria for neck and back pain are considered high-risk, a Monash study has found.
Potentially thousands of workers are receiving high-risk opioid prescriptions funded by workers’ compensation systems, says Monash University Professor Alex Collie.
The retrospective cohort study, published in CNS Drugs last week, analysed data from 30,590 employees in Victoria with neck and back injuries between 2010 and 2019 that made a workers’ compensation claim.
The Monash-led study found that 20.5% of the study participants were prescribed opioids within three months of their claim.
The RACGP currently states that opioid use for non-cancer chronic pain should not be the norm and should be approached cautiously, given the lack of evidence of their benefit for long-term use.
Short-term prescriptions, as with initiation of any medication, should be based on biopsychological assessment and considerations of the pros and cons.
Almost a quarter of study participants who were prescribed opioids continued to use the medication after a year.
Over two-thirds were given early high-risk opioid prescriptions.
Prescribing was deemed high-risk if large volumes were prescribed within three months, if long-acting opioids were prescribed early or if other high-risk medicines were prescribed in unison, like psychotropics.
According to the researchers, over 80% of participants were off work for more than three months, suggesting that the injuries may have been complex and significant thereby increasing the likelihood of high-risk opioid prescribing.
The likelihood of both long-term use and early high-risk prescribing was higher in rural and socioeconomically disadvantaged areas.
Professor Collie, the study’s senior author, said the data showed the extent of harmful early high-risk and long-term opioid use.
“More than 120,000 Australians have workers’ compensation claims involving more than a week off work every year, and many of these claims are for back and neck injuries,” he said.
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“If the patterns we observe in Victoria also occur in other states and territories, then potentially thousands of workers are receiving high-risk opioid prescriptions funded by our workers’ compensation systems.
“This study highlights the need for stronger monitoring of prescription patterns in our workers’ compensation systems, and the need for stronger approaches to prevent potentially harmful prescription opioid use.”
The paper’s first author Yonas Tefera said that early high-risk opioid use and long-term use were linked.
“We also found that early high-risk prescribing doubled the chances of long-term opioid use,” he said.
“Previous studies show that injured workers who use opioids early or for a long time tend to have more time off work and worse health outcomes.”
The researchers said efforts should be made to educate prescribers, and patients, on associated risks and to better monitor high-risk medications like opioids.
According to a study published in the Journal of Occupational and Environmental Medicine last May, Victoria is one of only two states where this analysis is possible because workers’ compensation schemes do not often track data on prescription medicines they are paying for.
