Associations between psychosocial factors and long‐term opioid use among injured workers receiving early opioids

Abstract Background Long‐term opioid use is related to numerous harms and has uncertain efficacy for chronic, non‐cancer pain. Identification of individuals at risk for long‐term opioid use can help support treatment decisions. The aim of this study was to determine psychosocial factors associated with opioid use 6 months after a work‐related injury. Methods This was a prospective observational cohort study incorporating surveys and administrative data. Eligibility included a workers' compensation claim for an injury between June 2019 and September 2021, no opioid use within 3 months before injury, and opioid use within 6 weeks after injury. The outcome was self‐reported opioid use at the 6‐month follow‐up survey (no use, use some days, or use most or every day). Multinomial logistic regression models were used to calculate relative risk ratios (RRRs) for associations between self‐reported psychosocial factors and long‐term opioid use. Results Of the 1724 respondents, 301 (17.5%) reported taking long‐term opioids on some days and 87 (5.0%) reported taking long‐term opioids on most or every day. After adjustment for sociodemographic and clinical covariates, workers reporting work fear‐avoidance had a higher relative risk of opioid use most or every day, versus no opioid use at the 6‐month survey, compared to those without work fear‐avoidance (RRR = 1.95, 95% CI = 1.08, 3.50). Anxiety symptoms, depression symptoms, and recovery expectations were not associated with long‐term opioid use after covariate adjustment. Conclusions Work fear‐avoidance was associated with long‐term opioid use in this study of injured workers. Addressing fears surrounding an injury and returning to work may help deter reliance on long‐term opioids.