Do Prescription Opioids After Traumatic Injury Increase the Risk of SSDI Entry? Instrumental Variables Estimates from the Colorado All-Payer Claims Database
I use panel data from the Colorado All-Payer Claims Database (CO APCD) to study how receipt of prescription opioids after traumatic injury affects the probability that workers transition from employment to Social Security Disability Insurance (SSDI). Although the CO APCD does not directly measure SSDI participation, I use Medicare enrollment before age 65 as a proxy for the event that an individual enters SSDI and remains enrolled through the 24-month Medicare waiting period. Workers who are opioid-naive at injury are much less likely to enter Medicare (0.58% at 48 months post-injury) than patients with a history of prescription opioid receipt at injury (2.21% at 48 months post-injury). Post-injury opioid receipt is also associated with Medicare entry. Opioid-naive patients who receive prescription opioids within 180 days post-injury are twice as likely (0.88%) to enter Medicare by 48 months postindex as opioid-naive patients with no opioids post-injury (0.44%), while patients with a history of prescription opioid receipt who receive prescription opioids within 180 days post-injury are about 2.5 times as likely (2.85%) to enter Medicare by 48 months postindex as opioid-naive patients with no opioids post-injury (1.11%). It is unclear if this relationship is causal, however: instrumental variables estimates provide some support for the hypothesis that opioid prescribing increases the probability of entering SSDI, but are ultimately inconclusive.
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