Early opioid prescription and subsequent disability among workers with back injuries: the Disability Risk Identification Study Cohort

Spine (Phila Pa 1976). 2008 Jan 15;33(2):199-204. doi: 10.1097/BRS.0b013e318160455c.


Study design: Prospective, population-based cohort study.

Objective: To examine whether prescription of opioids within 6 weeks of low back injury is associated with work disability at 1 year.

Summary of background data: Factors related to early medical treatment have been little investigated as possible risk factors for development of long-term work disability among workers with back injuries. We have previously shown that about 1 of 3 of workers receive an opioid prescription early after a low back injury, and a recent study suggested that such prescriptions may increase risk for subsequent disability.

Methods: We analyzed detailed data reflecting paid bills for opioids prescribed within 6 weeks of the first medical visit for a back injury among 1843 workers with lost work-time claims. Additional baseline measures included an injury severity rating from medical records, and demographic, psychosocial, pain, function, smoking, and alcohol measures from a worker survey conducted 18 days (median) after receipt of the back injury claim. Computerized database records of work disability 1 year after claim submission were obtained for the primary outcome measure.

Results: Nearly 14% (254 of 1843) of the sample were receiving work disability compensation at 1 year. More than one-third of the workers (630 of 1843) received an opioid prescription within 6 weeks, and 50.7% of these (319 of 630) were received at the first medical visit. After adjustment for pain, function, injury severity, and other baseline covariates, receipt of opioids for more than 7 days (odds ratio = 2.2; 95% confidence interval, 1.5-3.1) and receipt of more than 1 opioid prescription were associated significantly with work disability at 1 year.

Conclusion: Prescription of opioids for more than 7 days for workers with acute back injuries is a risk factor for long-term disability. Further research is needed to elucidate this association.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analgesics, Opioid / therapeutic use*
  • Back Injuries / drug therapy
  • Back Injuries / epidemiology*
  • Back Injuries / physiopathology
  • Cohort Studies
  • Disability Evaluation*
  • Disabled Persons / statistics & numerical data*
  • Female
  • Humans
  • Low Back Pain / drug therapy
  • Low Back Pain / epidemiology*
  • Male
  • Middle Aged
  • Occupational Diseases / drug therapy
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / physiopathology
  • Pain Measurement
  • Prospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Washington / epidemiology
  • Workers' Compensation / statistics & numerical data


  • Analgesics, Opioid