Association for Public Policy Analysis & Management

This study examines whether differences in opioids prescribing patterns influence duration of temporary disability benefits received by workers after a work-related injury. The study contributes to the literature by using methods designed to isolate a causal impact of opioids use on duration of disability. Specifically, we use local area variation in opioids prescriptions to construct instrumental variables for whether a given injured worker was given prescriptions for opioids. The idea behind this approach is that local prescribing patterns may influence whether an injured worker will use opioids. Indeed, we show that workers who live in areas where physicians are more likely to prescribe opioids were more likely to receive and fill opioids prescriptions, suggesting that physicians play a role in opioid use rates. At the same time, these prescribing patterns are likely to be exogenous with respect to unobserved workers’ characteristics. We examine the relationship between opioids and return to work using a sample of low-back pain injuries. For these injuries we have developed measures of severity that provide another set of controls not used in prior studies. When we examine whether a worker had any opioids prescriptions – without regard to the duration of opioid use – we find no relationship between opioids prescriptions and duration of temporary disability. However, we find that longer-term use of opioids leads to longer duration of temporary disability benefits.