Patients taking opioids over the long term don’t go back to work, yet many long-term opioid patients can be weaned off opioids within two years.

Joe Paduda

Those are the quick takeaways from two studies that came out in recent weeks.

First, a study from WCRI validates earlier research, finding:

• Patients with multiple opioid scripts are out of work three times longer than patients with no opioid scripts.
• Patients who lived in places where providers prescribe a lot of long-term opioids are more likely to get opioids for longer periods than individuals who lived elsewhere.

This is the first study that looked at ALL lost-time claims with a diagnosis of low-back pain in a very large area — 28 states that represent 80% of claims — over a five-year period. This is important because it shows  cause-and-effect independent of so-called “severity” measures, which often use cost, treatment or prescriptions to indicate medical severity, instead of actual clinical indicators.

By looking at ALL low-back claims with lost time, it is clear that the driver of disability is long-term prescribing of opioids.

The takeaway is this: Chronic use of opioids extends disability, and you can figure out where you need to focus your efforts by looking at publicly available prescribing data.

Which brings us to the good news: Weaning works, as research from California’s Workers’ Compensation Insurance Rating Bureau shows that 47% of the injured workers demonstrating chronic opioid usage were weaned off opioids completely within the 24-month study period. Injured workers who did not wean off completely over the study period still reduced opioid dosage by an average of 52%.

The research included all patients with more than 50 milligram morphine equivalents over at least 3 months within 24 months of the date of injury.

Yes, it is difficult, expensive, requires a lot of assistance from trained professionals and does not always work. All that said, given the finding that patients taking opioids for longer periods are out of work a lot longer, it is well worth the time and effort to help them reduce or end their use of opioids.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.