School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.
Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.
J Occup Rehabil. 2023 Mar;33(1):71-82. doi: 10.1007/s10926-022-10048-5. Epub 2022 Jun 3.
Purpose This study sought to determine patterns of opioid use among workers with a compensated lower limb injury, factors associated with opioid use, and how opioid use is associated with time loss duration. Methods Claims and medication data were provided by the workers' compensation regulator of Victoria, Australia, for claims lodged 2008-2018 from workers aged 15+ years with a lower limb injury. Descriptive statistics showed the number and prevalence of each opioid type (weak/strong) by demographic, claim and injury predictors. Binary and multinomial logistic regression determined the likelihood of any opioid use, and use of strong, weak or a combination of strong and weak opioids by predictors. Cox regression determined the effect of each opioid type on duration of time loss, controlling for predictors. Results There were 51,334 claims and of these 23.6% were dispensed opioids (9.2% for strong opioids only, 6.6% for weak opioids only and 7.8% for a combination). Weak opioids, on average, were dispensed 15 days earlier than strong opioids. Time loss claims and workers with fractures or hip injuries were most likely to be dispensed opioids. All opioids were associated with increased duration of time loss, with those dispensed both weak and strong opioids having the longest duration of time loss. Conclusions Any opioid use was associated with longer time loss duration, with increasing opioid strength having a greater effect. Review of pain management methods should be undertaken to reduce opioid use, which may have a positive impact on duration of time loss and long-term function.
目的 本研究旨在确定下肢损伤赔偿工人的阿片类药物使用模式、与阿片类药物使用相关的因素，以及阿片类药物使用与误工持续时间的关系。
方法 澳大利亚维多利亚州工人赔偿监管机构提供了 2008 年至 2018 年期间年龄在 15 岁及以上的下肢损伤工人的索赔和药物数据。描述性统计显示了按人口统计学、索赔和损伤预测因素分类的每种阿片类药物（弱/强）的数量和流行率。二元和多项逻辑回归确定了预测因素对任何阿片类药物使用以及强阿片类药物、弱阿片类药物或强阿片类药物和弱阿片类药物组合使用的可能性。Cox 回归确定了每种阿片类药物类型对误工持续时间的影响，同时控制了预测因素。
结果 共有 51334 项索赔，其中 23.6%（9.2%仅为强阿片类药物，6.6%仅为弱阿片类药物，7.8%为强阿片类药物和弱阿片类药物的组合）开出了阿片类药物。弱阿片类药物的平均处方时间比强阿片类药物早 15 天。有误工索赔和髋部骨折或髋关节损伤的工人最有可能开出阿片类药物。所有阿片类药物都与误工时间延长有关，同时开具弱阿片类药物和强阿片类药物的工人误工时间最长。
结论 任何阿片类药物的使用都与更长的误工持续时间有关，而且阿片类药物强度的增加会产生更大的影响。应该审查疼痛管理方法，以减少阿片类药物的使用，这可能对误工持续时间和长期功能产生积极影响。
