Postsurgical Opioid Prescribing Among Injured Workers in Washington State: 2017–2020 Trends and Policy Effects

IF 2.4 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

American journal of industrial medicine Pub Date : 2026-08-10 Epub Date: 2026-06-28 DOI:10.1002/ajim.70098

John R. Haight, Deborah Fulton-Kehoe, Anjum Hajat, Joel D. Kaufman, Gary M. Franklin

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引用次数: 0

Abstract

Introduction

The widespread adoption of longer duration opioid prescribing for acute pain management following surgeries has coincided with concerning increases in misuse, dependence, and overdose. We evaluated the impact of voluntary opioid prescribing guidelines and concurrent state pharmacy rules on prescribing trends following surgeries for work-related injuries.

Methods

We analyzed claims data for surgical and postoperative care in the Washington State workers' compensation system, linked with prescription drug monitoring program data, from 2017 to 2020. We evaluated whether rates of long-duration opioid prescribing (> 14 opioid days) or persistent opioid prescribing (3–6 months post-surgery) decreased after the implementation of Washington State's postsurgical opioid prescribing guidelines and pharmacy rules (2018–2019), using an interrupted time-series analysis, stratified by surgical severity.

Results

Prior to policy implementation, longer duration opioid prescribing was declining at a rate of 0.52 percentage points per month, on average, among all surgeries. Following the promulgation of guidelines and rules, this decline slowed significantly to 0.14 percentage points monthly (slope change: +0.38 percentage points; 95% CI: 0.11, 0.65). Similar decelerations were observed across surgical severity types. Persistent opioid use following surgery remained steady, around 6.8%.

Conclusions

Overall declines in longer duration opioid prescribing continued steadily after policy implementation, however, Washington State's postsurgical opioid prescribing guidelines and rules were associated with a modest slowing of pre-existing downward trends in longer duration opioid prescribing, counter to expectations. These findings suggest that voluntary guidelines may have had limited impact. More robust implementation strategies may be needed to further reduce longer duration postsurgical opioid prescribing patterns in a workers' compensation setting.

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华盛顿州受伤工人的术后阿片类药物处方：2017-2020年趋势和政策影响。

前言：在手术后急性疼痛管理中广泛采用更长时间的阿片类药物处方，同时也伴随着滥用、依赖和过量的增加。我们评估了自愿阿片类药物处方指南和同时的州药房规则对工伤手术后处方趋势的影响。方法：我们分析了2017年至2020年华盛顿州工人赔偿系统中与处方药监测项目数据相关的手术和术后护理索赔数据。我们使用中断时间序列分析，按手术严重程度分层，评估华盛顿州术后阿片类药物处方指南和药房规则（2018-2019）实施后，长期阿片类药物处方（bbb14阿片类药物日）或持续阿片类药物处方（术后3-6个月）的发生率是否下降。结果：政策实施前，在所有手术中，持续时间较长的阿片类药物处方以平均每月0.52个百分点的速度下降。随着指导方针和规则的颁布，这种下降明显放缓至每月0.14个百分点（斜率变化：+0.38个百分点；95% CI: 0.11, 0.65）。不同手术严重程度的患者均观察到类似的减速。手术后持续阿片类药物的使用保持稳定，约为6.8%。结论：在政策实施后，长期阿片类药物处方的总体下降持续稳定，然而，华盛顿州的术后阿片类药物处方指南和规则与长期阿片类药物处方先前存在的下降趋势适度放缓有关，这与预期相反。这些发现表明，自愿指导方针的影响可能有限。可能需要更强有力的实施战略，以进一步减少工人补偿环境中持续时间较长的术后阿片类药物处方模式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of industrial medicine 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.90

自引率

5.70%

发文量

108

审稿时长

4-8 weeks

期刊介绍： American Journal of Industrial Medicine considers for publication reports of original research, review articles, instructive case reports, and analyses of policy in the fields of occupational and environmental health and safety. The Journal also accepts commentaries, book reviews and letters of comment and criticism. The goals of the journal are to advance and disseminate knowledge, promote research and foster the prevention of disease and injury. Specific topics of interest include: occupational disease; environmental disease; pesticides; cancer; occupational epidemiology; environmental epidemiology; disease surveillance systems; ergonomics; dust diseases; lead poisoning; neurotoxicology; endocrine disruptors.