Bending the prescription opioid dosing and mortality curves: impact of the Washington State opioid dosing guideline

Am J Ind Med. 2012 Apr;55(4):325-31. doi: 10.1002/ajim.21998. Epub 2011 Dec 27.


Background: Opioid use and dosing for patients with chronic non-cancer pain have dramatically increased over the past decade, resulting in a national epidemic of mortality associated with unintentional overdose, and increased risk of disability among injured workers. We assessed changes in opioid dosing patterns and opioid-related mortality in the Washington State (WA) workers' compensation system following implementation of a specific WA opioid dosing guideline in April, 2007.

Methods: Using detailed computerized billing data from WA workers' compensation, we report overall prevalence of opioid prescriptions, average morphine-equivalent dose (MED)/day, and proportion of workers on disability compensation receiving opioids and high-dose (≥120 mg/day MED) opioids over the past decade. We also report the trend of unintentional opioid deaths during the same time period.

Results: Compared to before 2007, there has been a substantial decline in both the MED/day of long-acting DEA Schedule II opioids (by 27%) and the proportion of workers on doses ≥120 md/day MED (by 35%). There was a 50% decrease from 2009 to 2010 in the number of deaths.

Conclusions: The introduction in WA of an opioid dosing guideline appears to be associated temporally with a decline in the mean dose for long-acting opioids, percent of claimants receiving opioid doses ≥120 mg MED per day, and number of opioid-related deaths among injured workers.

MeSH terms

  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / poisoning*
  • Chronic Pain / drug therapy
  • Drug Overdose / mortality
  • Drug Prescriptions / statistics & numerical data*
  • Humans
  • Occupational Diseases / drug therapy
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Practice Patterns, Physicians' / trends
  • Washington
  • Workers' Compensation / statistics & numerical data*


  • Analgesics, Opioid