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

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 opioidrelated deaths among injured workers. Am. J. Ind. Med. 55: 325-331, 2012. (C) 2011 Wiley Periodicals, Inc.