Fewer injured workers are receiving opioids compared with previous years, and it appears opioid drugs are being replaced with nonopioid pain medications and nonpharmacologic treatments like physical therapy, according to a study released Tuesday.

In the study, researchers from the Cambridge, Massachusetts-based Workers Compensation Research Institute examined more than 575,000 nonsurgical claims and 4.3 million prescriptions associated with those claims in 27 states between October 2011 and March 2018, finding that the number of injured workers being prescribed opioids post-accident declined in all states studied. However, opioid prescribing continues to be prevalent among nonsurgical claims with more than seven days of lost time, according to the study.

In Illinois, the number of prescriptions for opioids given to injured workers declined by 8%; and in California, the number declined by 25%. The average morphine milligram equivalent also dropped in nearly all states, with the average decreasing more than 50% in California, Connecticut and Kentucky.

In 22 of 27 states, the percentage of prescriptions for nonopioid pain medications increased by more than 10% — showing a shift in physician prescribing patterns, the researchers said — and in most states, the number of injured workers who received nonpharmacologic prescriptions like physical therapy and no prescription drugs also increased.

However, substantial variation in opioid dispensing remains between states, the study revealed. Delaware, Louisiana, Pennsylvania and New York had the highest amount of opioids dispensed per claim 2016 through 2018, with Louisiana and Delaware claimants receiving more than 3,000 milligrams of opioids per claim, followed by Pennsylvania where about 2,000 milligrams of opioids were prescribed per claim. Among states with the lowest levels of opioids dispensed per claim, Missouri’s injured workers with opioid prescriptions received an average of about 600 milligrams per claim. The researchers said the figures from Delaware, Louisiana and Pennsylvania were “striking” considering the sample of nonsurgical claims used in the study.

In states where a higher proportion of claims had a first opioid prescription exceeding one or two weeks of supply, the chronic opioid use rate was also higher, which means injured workers were more likely to receive at least a 60-day supply of opioids over any 90-day period, the researchers said. Opioid prescribing continues to be prevalent among nonsurgical claims with more than seven days of lost time, according to the study.

The 27 states in the study included Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.