Opioid prescribing within the workers’ compensation system in general has been a cause for concern. The objective of the study was to estimate the prevalence of opioid users among injured workers, referred at a Tertiary Care Pain Clinic, in 2008-2009. A cross-sectional retrospective study of 110 consecutive workers; male/female ratio was 2.3:1; mean age 45.5 years; mean pain ratings were 7.1±1.8. 21% of the workers were diagnosed with a biomedical problem (Group I), 51% with medical/psychological factors (Group II) and 25.5% had identifiable psychological factors but no physical pathology (Group III). Opioids were prescribed in 81.8%; of those 32.2% were on >200mg of daily morphine or equivalent (MED). A higher proportion of opioid users were in Group II and Group III than Group I. The vast majority of referred injured workers in this study were on opioid therapy with 1 in 3 exceeding the “watchful” dose of 200 mg MED

Opioid prescribing within the workers’ compensation system in general has been a cause for concern. The objective of the study was to estimate the prevalence of opioid users among injured workers, referred at a Tertiary Care Pain Clinic, in 2008-2009. A cross-sectional retrospective study of 110 consecutive workers; male/female ratio was 2.3:1; mean age 45.5 years; mean pain ratings were 7.1±1.8. 21% of the workers were diagnosed with a biomedical problem (Group I), 51% with medical/psychological factors (Group II) and 25.5% had identifiable psychological factors but no physical pathology (Group III). Opioids were prescribed in 81.8%; of those 32.2% were on >200mg of daily morphine or equivalent (MED). A higher proportion of opioid users were in Group II and Group III than Group I. The vast majority of referred injured workers in this study were on opioid therapy with 1 in 3 exceeding the “watchful” dose of 200 mg MED

This dissertation focuses on the health, health care utilization rates, and unmet health care needs of individuals aging with work-related impairments. A life course perspective is used to understand the health experiences of these individuals, and a mixed method approach was used to study their health and health care use. Three components make up the dissertation, two quantitative projects and one qualitative project. The first article provides a broad overview of chronic health conditions reported by respondents from the Research Action Alliance on the Consequences of Work Injury (RAACWI) Health and Health Care Utilization Survey who experienced a work-related impairment. Health outcomes and access to health care for this group is compared to a similar aged sample of Ontarian respondents from the Canadian Community Health Survey. The second article uses the National Population Health Survey to examine whether rates of unmet health care needs over eight cycles varied based on disability status. Respondents are categorized as either without disability, having a work-related disability, having a disability as a result of a disease or illness, or having disability for other reasons. The reasons for unmet health care needs is examined for seven cycles to determine whether unmet health care need could be characterized as personal or structural. The third article provides a deeper understanding of how 11 individuals age with a work injury. A convenience sample of 11 participants from the RAACWI Health Survey participated in semi-structured, in-depth interviews where they discussed their work injury and how they are coping with its ongoing consequences, including subsequent health problems as they age. This article provides a richer understanding of health changes and unmet health care needs that could not be examined in the other projects due to the nature of quantitative analysis. Together these three articles enable me to showcase the lived experiences of individuals with work-related impairments and how they age with the work injury and subsequent, additional chronic health conditions. / Dissertation / Candidate in Philosophy

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