Changes in early high-risk opioid prescribing practices after policy interventions in Washington State

Health Serv Res. 2021 Feb;56(1):49-60. doi: 10.1111/1475-6773.13564. Epub 2020 Oct 4.


Objective: To test associations between several opioid prescribing policy interventions and changes in early (acute/subacute) high-risk opioid prescribing practices.

Data sources: Population-based workers' compensation pharmacy billing and claims data, Washington State Department of Labor and Industries (January 2008-June 2015).

Study design: We used interrupted time series analysis to test associations between three policy intervention timepoints and monthly proportions of population-based measures of high-risk, low-risk, and any workers' compensation-related opioid prescribing. We also tested associations between the policy intervention timepoints and five high-risk opioid prescribing indicators among workers prescribed any opioids within 3 months after injury: (a) >7 cumulative (not necessarily consecutive) days' supply of opioids during the acute phase, (b) high-dose opioids, (c) concurrent sedatives, (d) chronic opioids, and (e) a composite high-risk opioid prescribing indicator.

Principal findings: Within 3 months after injury, 9 percent of workers were exposed to high-risk and 12 percent to low-risk workers' compensation-related opioid prescribing; 79 percent filled no workers' compensation-related opioid prescription. Among workers prescribed any early (acute/subacute) opioids, the indicator for >7 days' supply of opioids during the acute phase was present for 30 percent, high-dose opioids for 18 percent, concurrent sedatives for 3 percent, and chronic opioids for 2 percent. Beyond a general shift toward more infrequent and lower-risk workers' compensation-related opioid prescribing, each policy intervention timepoint was significantly associated with reductions in specific acute/subacute high-risk opioid prescribing indicators; each of the four specific high-risk opioid prescribing indicators had significant reductions associated with at least one policy.

Conclusions: Several state-level opioid prescribing policies were significantly associated with safer workers' compensation-related opioid prescribing practices during the first 3 months after injury (acute/subacute phase), which should in turn reduce transition to chronic opioids and associated negative health outcomes.

Keywords: analgesics; drug prescriptions; inappropriate prescribing; interrupted time series analysis; opioid; policy; workers’ compensation.

Publication types

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

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Chronic Pain / drug therapy*
  • Chronic Pain / epidemiology
  • Drug Prescriptions / statistics & numerical data*
  • Humans
  • Interrupted Time Series Analysis
  • Occupational Diseases / drug therapy*
  • Occupational Diseases / epidemiology
  • Practice Patterns, Physicians' / statistics & numerical data
  • Treatment Outcome
  • Washington
  • Workers' Compensation


  • Analgesics, Opioid