Brief report: Population-based reversal of the adverse impact of opioids on disability in Washington State workers' compensation

Am J Ind Med. 2019 Feb;62(2):168-174. doi: 10.1002/ajim.22937. Epub 2018 Dec 28.


Background: Evidence has associated opioid use initiated early in a workers' compensation claim with subsequent disability. In 2013, the Washington State Department of Labor and Industries (DLI) implemented procedures based on new regulations that require improvement in pain and function to approve opioids beyond the acute pain period.

Methods: We measured opioid prescriptions between 6 and 12 weeks following injury, an indicator of persistent opioid use. Actuarial data for the association of any opioid use versus no opioid use with development of lost time payments are reported.

Results: Prior authorization with hard stops led to a sustained drop in persistent opioid use, from nearly 5% in 2013 to less than 1% in 2017. This reduction was also associated with reversal of the increased lost work time patterns seen from 1999 to 2010.

Conclusions: Prior authorization targeted at preventing transition to chronic opioid use can prevent and reverse adverse time loss development that has occurred on a population basis concomitant with the opioid epidemic.

Keywords: disability; opioids; prior authorization; workers’ compensation.

MeSH terms

  • Accidents, Occupational*
  • Analgesics, Opioid / therapeutic use*
  • Disabled Persons
  • Drug Prescriptions / statistics & numerical data*
  • Humans
  • Pain / drug therapy
  • Washington
  • Workers' Compensation / trends*


  • Analgesics, Opioid