Understanding the use and impact of early opioid prescriptions for work-related low-back pain

Reasons for the study

Prescription opioid use among workers with musculoskeletal disorders is a significant source of concern for the workers' compensation system. Prior studies suggest opioids prescribed shortly after a claim for low-back pain (LBP) can lead to prolonged work disability. However, these studies likely underestimated prescriptions, did not always distinguish exposure from outcome windows, and did not account for potential confounding factors, such as pre-injury health care and prescriptions, use of other therapies, and comorbidities. They also compared opioid users to non-users, the latter of which may include claimants who may differ in injury severity. The objective of this study is to address some of these limitations and provide further clarity on this important issue.

Objectives of the study

  • To describe pre- and post-injury patterns of health care and LBP-relevant prescription dispensing and their associated factors
  • To describe post-injury prescription dispensing patterns over time
  • To assess the validity of workers’ compensation prescription billing data
  • To describe post-claim opioid prescription patterns suggestive of possible opioid misuse or problematic prescribing
  • To determine if prescription opioids dispensed within the first eight weeks of filing a new workers' compensation lost-time claim for LBP are associated with future work disability compared to nonsteroidal anti-inflammatory drugs or muscle relaxants

Anticipated results/impact

These findings may help inform new and existing policies in workers’ compensation systems. They may also be relevant to physicians with respect to clinical practice patterns.

Related scientific publications

Carnide N, Hogg-Johnson S, Furlan AD, Cote P, Koehoorn M. Prescription dispensing patterns before and after a workers' compensation claim: an historical cohort study of workers with low back pain injuries in British Columbia. Journal of Occupational and Environmental Medicine. 2018;60(7):644-655. doi:10.1097/JOM.0000000000001311.
Carnide N, Hogg-Johnson S, Cote P, Irvin E, Van Eerd D, Koehoorn M, Furlan AD. Early prescription opioid use for musculoskeletal disorders and work outcomes: a systematic review of the literature. Clinical Journal of Pain. 2017;33(7):647. doi:10.1097/AJP.0000000000000452.

Project status

Completed 2017

Research team

Sheilah Hogg-Johnson, Institute for Work & Health (PI)
Nancy Carnide, Institute for Work & Health
Andrea Furlan, Institute for Work & Health
Hyunmi Lee, Institute for Work & Health
Pierre Côté, University of Ontario Institute of Technology
Mieke Koehoorn, University of British Columbia

Participating organizations


Funded by

Canadian Institutes of Health Research, WorkSafeBC