Morphine Equivalent Dose-Days (MED-D): Predicting the Impact of Opioid Prescription on Total Workers' Compensation Claim Costs for Acute Low Back Pain

J Occup Environ Med. 2020 Sep;62(9):700-705. doi: 10.1097/JOM.0000000000001958.


Objective: To assess the effect of morphine equivalent dose-days (MED-D) on the total cost for acute low back pain (LBP) workers' compensation claims.

Methods: Simple random samples of 123 opioid and 141 nonopioid acute LBP claims were obtained. Opioid claims were divided into low, medium, and high subgroups for MED-D, MED, and prescription duration. Subgroup mean total costs were compared to the nonopioid group using multivariate regression analyses.

Results: MED-D and prescription duration were each, respectively, associated with significantly increased total costs at both medium and high levels. Increasing MED had a negative association with total cost, though stratification by duration abrogated this perceived trend. Interaction testing indicated MED and duration together better explained cost than MED alone.

Conclusion: MED-D is a better predictor of total cost in acute LBP claims than MED alone.

Publication types

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

MeSH terms

  • Analgesics, Opioid* / administration & dosage
  • Analgesics, Opioid* / therapeutic use
  • Drug Prescriptions
  • Humans
  • Low Back Pain* / drug therapy
  • Low Back Pain* / economics
  • Morphine
  • Workers' Compensation* / economics


  • Analgesics, Opioid
  • Morphine