Issue:
Some WCB-Alberta claimants on opioid analgesics for pain management have been noted to receive very high prescribed opioid doses (up to about 10,000 mg morphine equivalent per day, i.e. two orders of magnitude larger than what is now generally regarded as a safe upper limit). Despite such high doses of opioid pain medications, a substantial number of these individuals have poor pain control, are in a low functional state, and are not at work. High prescribed opioid use among WCB claimants has been identified as an area of concern at WCB-Alberta.
This project will analyze opioid dose, pain intensity, functional outcomes, and safety outcomes among WCB-Alberta claimants with non-cancer pain who are on high opioid doses (200mg morphine equivalents per day or more).
Objectives:
This study aims to discover answers to the following questions:
• How well is pain controlled in WCB claimants with non-cancer chronic pain who are on opioid doses of 200 mg morphine equivalents or more per day?
• What is the functional status of these claimants? Does functional status improve as opioid dose is increased? What proportion of these claimants are working?
• What are the dose-response relationships in terms of pain control and function for opioid doses in excess of 200 mg morphine equivalents per day?
• What proportion of claimants have suffered an opioid-adverse event, that led to hospitalization, for example? What proportion have had an identified opioid-adverse event? How many have died from a cause related to high dose opioid therapy?
Anticipated Results:
This study will shed light on the benefits and harms of high dose opioid therapy and allow us to formulate evidence-based practice recommendations for or against the use of high dose opioids for chronic non-cancer pain. Since the data for the analysis comes from WCB-Alberta claimants, the results would be directly applicable to clinical practice in Alberta and opioid prescriptions paid for by WCB-Alberta.
Investigators:
Dr. Sebastian Straube (University of Alberta)
