Predictors of long-term opioid use and opioid use disorder among construction workers: Analysis of claims data

Abstract

Background: Construction workers have high rates of work-related musculoskeletal disorders, which lead to frequent opioid use and opioid use disorder (OUD). This paper quantified the incidence of opioid use and OUD among construction workers with and without musculoskeletal disorders.

Methods: We conducted a retrospective study using union health claims from January 2015 to June 2018 from 19,909 construction workers. Claims for diagnoses of chronic musculoskeletal disorders, acute musculoskeletal injuries, musculoskeletal surgery, and other conditions were linked to new opioid prescriptions. We examined the effects of high doses (≥50 morphine mg equivalents per day), large supply (more than 7 days per fill), long-term opioid use (60 or more days supplied within a calendar quarter), and musculoskeletal disorders, on the odds of a future OUD.

Results: There were high rates (42.8% per year) of chronic musculoskeletal disorders among workers, of whom 24.1% received new opioid prescriptions and 6.3% received long-term opioid prescriptions per year. Workers receiving opioids for chronic musculoskeletal disorders had the highest odds of future OUD: 4.71 (95% confidence interval 3.09-7.37); workers prescribed long-term opioids in any calendar quarter had a nearly 10-fold odds of developing an OUD.

Conclusions: Among construction workers, opioids initiated for musculoskeletal pain were strongly associated with incident long-term opioid use and OUD. Musculoskeletal pain from physically demanding work is likely one driver of the opioid epidemic in occupations like construction. Prevention of work injuries and alternative pain management are needed for workers at risk for musculoskeletal injuries.

Keywords: blue collar worker; musculoskeletal disorders; opioid prescriptions; pain treatment.

Figure 1:

Prevalence of construction workers who received opioids within 3 days of diagnosis by the proportion with each diagnosis Gray columns show the fraction of workers who were initiated on opioid therapy and black columns show the fraction of workers who had long-term opioid use, where long-term is defined as >= 60 days of prescription opioids supply in a subsequent 90-day period. Column widths are proportional to the number of workers within each diagnostic category (see text for ICD-9 and -10 codes). Musculoskeletal (MSK) Surgery column includes workers with MSK surgery, with or without chronic MSK disorder or acute MSK injury. ICD: International Classification of Disease

Figure 2.

Odds of opioid use disorder among those receiving opioid prescriptions (n=5057) Forest plot of multivariable logistic regression models for the outcome of opioid use disorder (diagnosis of opioid use disorder or poisoning, or receiving buprenorphine) and a predictor variable (musculoskeletal condition, other diagnosis, or the opioid prescriptions) after adjusting for age, gender, mental health among workers who received opioids and followed for up to one-year after the fill of the first prescription. Each opioid prescription was linked to a visit up to three days prior to the prescription. If more than one diagnosis was assigned on a single visit or claim, the assigned claim followed the order of acuity (musculoskeletal (MSK) surgery, acute MSK injury, chronic MSK disorder, other diagnosis). The odds ratio shows the odds of developing an opioid use disorder within one year after filling an opioid prescription assigned to one or more of the health conditions or to the dose and supply of opioids. The first opioid prescription filled in the database for each worker was used in this analysis. MME: Morphine milligram equivalents, MSK: musculoskeletal