Opioid dosing trends and mortality in Washington State workers' compensation, 1996-2002

被引:119
作者
Franklin, GM
Mai, J
Wickizer, T
Turner, JA
Fulton-Kehoe, D
Grant, L
机构
[1] Univ Washington, Dept Environm & Occupat Hlth Sci, Occupat Epidemiol & Hlth Outcomes Program, Seattle, WA 98103 USA
[2] Washington State Dept Labor & Ind, Olympia, WA 98504 USA
[3] Univ Washington, Sch Publ Hlth & Community Med, Dept Hlth Serv, Seattle, WA 98195 USA
[4] Univ Washington, Sch Med, Dept Psychiat & Behav Sci, Seattle, WA USA
[5] Univ Washington, Sch Med, Dept Rehabil Med, Seattle, WA USA
关键词
chronic pain; mortality; opioids; workers' compensation;
D O I
10.1002/ajim.20191
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background The use of opioids for chronic non-cancer pain has increased in the United States since state laws were relaxed in the late 1990s. These policy changes occurred despite scanty scientific evidence that chronic use of opioids was safe and effective. Methods We examined opiate prescriptions and dosing patterns (from computerized databases, 1996 to 2002), and accidental poisoning deaths attributable to opioid use (from death certificates, 1995 to 2002), in the Washington State workers' compensation system. Results Opioid prescriptions increased only modestly between 1996 and 2002. However, prescriptions for the most potent opioids (Schedule II), as a percentage of all scheduled opioid prescriptions (11, 111, and IV), increased from 19.3% in 1996 to 37.2% in 2002. Among long-acting opioids, the average daily morphine equivalent dose increased by 50%, to 132 mg/day. Thirty-two deaths were definitely or probably related to accidental overdose of opioids. The majority of deaths involved men (84%) and smokers (69%). Conclusions The reasons for escalating doses of the most potent opioids are unknown, but it is possible that tolerance or opioid-induced abnormal pain sensitivity maybe occurring in some workers who use opioids for chronic pain. Opioid-related deaths in this population may be preventable through use of prudent guidelines regarding opioid use for chronic pain.
引用
收藏
页码:91 / 99
页数:9
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