Associations between psychosocial factors and long-term opioid use among injured workers receiving early opioids

Background: Long-term opioid use is related to numerous harms and has uncertain efficacy for chronic, non-cancer pain. Identification of individuals at risk for long-term opioid use can help support treatment decisions. The aim of this study was to determine psychosocial factors associated with opioid use 6 months after a work-related injury. Methods: This was a prospective observational cohort study incorporating surveys and administrative data. Eligibility included a workers' compensation claim for an injury between June 2019 and September 2021, no opioid use within 3 months before injury, and opioid use within 6 weeks after injury. The outcome was self-reported opioid use at the 6-month follow-up survey (no use, use some days, or use most or every day). Multinomial logistic regression models were used to calculate relative risk ratios (RRRs) for associations between self-reported psychosocial factors and long-term opioid use. Results: Of the 1724 respondents, 301 (17.5%) reported taking long-term opioids on some days and 87 (5.0%) reported taking long-term opioids on most or every day. After adjustment for sociodemographic and clinical covariates, workers reporting work fear-avoidance had a higher relative risk of opioid use most or every day, versus no opioid use at the 6-month survey, compared to those without work fear-avoidance (RRR = 1.95, 95% CI = 1.08, 3.50). Anxiety symptoms, depression symptoms, and recovery expectations were not associated with long-term opioid use after covariate adjustment. Conclusions: Work fear-avoidance was associated with long-term opioid use in this study of injured workers. Addressing fears surrounding an injury and returning to work may help deter reliance on long-term opioids.