Are injured workers with higher rehabilitation service utilization less likely to be persistent opioid users? A cross-sectional study.

BACKGROUND: Given its role in treating musculoskeletal conditions, rehabilitation medicine may be an important factor in decreasing the use of opioids among injured workers. The primary objective was to determine if increased utilization of rehabilitation services was associated with decreased persistent opioid use among workers' compensation claimants. The secondary objective was to determine the combined association of rehabilitation service utilization and persistent opioid use with days of work lost due to injury. METHODS: Using Chesapeake Employers' Insurance Company claims data from 2008 to 2016, claimants with at least one filled opioid prescription within 90 days of injury were eligible for inclusion. The primary outcome was persistent opioid use, defined as at least one filled opioid prescription more than 90 days from injury. The secondary outcome was days lost due to injury. The primary variable of interest, rehabilitation service utilization, was quantified based on the number of rehabilitation service claims and grouped into five levels (no utilization, and four quartiles - low, medium, high, very high). RESULTS: Of the 9596 claimants included, 29% were persistent opioid users. Compared to claimants that did not utilize rehabilitation services, patients with very high rehabilitation utilization were nearly three times more likely (OR: 2.71, 95% CI: 2.28-3.23, p < 0.001) to be persistent opioid users and claimants with low and medium levels of rehabilitation utilization were less likely to be persistent opioid users (low OR: 0.20, 95%: 0.14-0.27, p < 0.001) (medium OR: 0.26, 95% CI: 0.21-0.32, p < 0.001). Compared to claimants that did not utilize rehabilitation services, very high rehabilitation utilization was associated with a 27% increase in days lost due to the injury (95% CI: 21.9-32.3, p < 0.001), while low (- 16.4, 95% CI: -21.3 - -11.5, p < 0.001) and medium (- 11.5, 95% CI: -21.6 - -13.8, p < 0.001) levels of rehabilitation utilization were associated with a decrease in days lost due to injury, adjusting for persistent opioid use. CONCLUSION: Our analysis of insurance claims data revealed that low to moderate levels of rehabilitation was associated with reduced persistent opioid use and days lost to injury. Very high rehabilitation utilization was associated with increased persistent opioid use and increased time from work.

Factors Associated With Persistent Opioid Use Among Injured Workers' Compensation Claimants.

Importance: There is a paucity of data on persistent opioid use and factors associated with persistent opioid use among workers' compensation claimants. Objective: To determine the proportion of injured workers who filled an opioid prescription beyond 90 days from injury and the factors associated with persistent opioid use among workers' compensation claimants. Design, Setting, Participants: This retrospective cohort study collected workers' compensation claims data from January 1, 2008, to December 31, 2016, from the Chesapeake Employers' Insurance Company in Maryland. All workers' compensation claimants injured during the study years and with at least 1 filled opioid prescription were eligible for inclusion. For patients who had unique injury claims in multiple years of the study, only the first claimed injury was included in our analysis. Patients who died as a result of the claimed injury were excluded. The analysis was performed between October 2017 and August 2018. Main Outcomes and Measures: The primary outcome was persistent opioid use, defined as an opioid prescription fulfillment beyond 90 days from the date of injury. Multivariable regression was used to determine prognostic factors of persistent opioid use. Results: Of the 9596 study participants (mean [SD] age, 43 [12.3] years; 6218 [65.1%] male), 2741 (28.6%) filled an opioid prescription more than 90 days from their date of injury. Participants aged 60 years or older (odds ratio [OR], 1.92; 95% CI, 1.56-2.36), crush injuries (OR, 1.55; 95% CI, 1.28-1.89), strain and sprain injuries (OR, 1.54; 95% CI, 1.36-1.75), annual income more than $60 000 (OR, 1.31; 95% CI, 1.07-1.61), and concomitant diagnoses for chronic joint pain (OR, 1.98; 95% CI, 1.79-2.20) were significantly associated with persistent opioid use. Compared with workers with claims designated as permanent partial disability, workers with medical-only claims were significantly less likely to have persistent opioid use at 90 days postinjury (OR, 0.17; 95% CI, 0.15-0.20). Conclusions and Relevance: A high proportion of persistent opioid use was observed in this workers' compensation cohort. Interventions to lower persistent opioid use in this population should target patients with the characteristics identified in this study.