953 The relationship between early prescription dispensing patterns and work disability in a cohort of low back pain workers’ compensation claimants
Bibliographic record
Abstract
Introduction Opioids are prescribed early among workers’ compensation claimants with low back pain (LBP), despite little evidence supporting this practice. The comparative effect of early opioids relative to other medications on work disability is unknown. The objective was to examine the association between prescription opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and skeletal muscle relaxants (SMRs) dispensed in the first eight weeks following a compensated, work-related low back injury and work disability. Methods Historical cohort study of workers’ compensation claimants in British Columbia, Canada filing a short-term claim for a LBP injury. Exposure variables were constructed using dispensing data from the first eight weeks after injury: drug class(es) dispensed, drug class(es) at first dispense, days supply, strength of opioids dispensed, and average daily morphine-equivalent dose (MED). Two outcomes (time on benefits, any benefit receipt) after eight weeks and up to one year were considered. Results Compared to claimants receiving NSAIDs and/or SMRs only, the incidence rate ratio (IRR) of days on benefits for claimants dispensed opioids only or opioids with NSAIDs and/or SMRs was 1.09 (95% CI: 1.04 to 1.14) and 1.26 (95% CI: 1.22 to 1.30), respectively. The IRR for claimants dispensed strong opioids only or strong and weak opioids combined was 1.21 (95% CI: 1.12 to 1.30) and 1.29 (95% CI: 1.20 to 1.39), respectively, compared to weak opioids only. Each 7 day increase in supply of opioids, NSAIDs, and SMRs resulted in a 10%, 4%, and 3% increase, respectively, in rate of days on benefits. Each 30 mg/day increase in daily MED resulted in a 4% increase in rate of days on benefits. Larger effect sizes were seen for benefit receipt outcome. Discussion Findings suggest early opioid provision has an adverse effect on work disability. However, residual confounding likely accounts for some of the findings. Research is needed that accounts for prescriber, system, and workplace factors and elucidates the mechanism underlying the relationship.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".