Drug Overdose in the Workplace and the Role of Opioids

The drug overdose epidemic continues to afflict our country. Nationally, there were more than 70,000 drug overdose deaths in 2017 [i] involving opioids (such as fentanyl, heroin and hydrocodone), stimulants (such as cocaine and methamphetamine), and alcohol.[ii] Nearly 70% of these deaths involved an opioid.[ii]

Recent data show that drug overdoses at work are increasing. A National Institute for Occupational Safety and Health (NIOSH) analysis of Bureau of Labor Statistics national data identified that while drug overdose deaths were less frequent compared with other causes of occupational injury deaths, there was an annual increase of 24% in drug overdose deaths between 2011 and 2016. Opioids, including heroin and prescription drugs, and illicitly manufactured fentanyl accounted for 44% of the drug overdose deaths at work between 2011 and 2016.[iii] Illicit drugs such as methamphetamine, phencyclidine (PCP) and cocaine accounted for 24% of these deaths.

This disturbing trend has been identified in Massachusetts, where the state’s Department of Public Health recently released a report showing that unintentional drug overdoses were the leading cause of workplace death in Massachusetts in 2016 and 2017. Of the 54 drug overdose deaths that occurred in Massachusetts workplaces, 85% involved fentanyl, the highly potent synthetic opioid. The average age of workplace overdose death victims was 39.

The high proportion of opioid overdose deaths in Massachusetts may be due to several factors. First, the overall extent of the opioid overdose epidemic in the state which has seen opioid-overdose deaths triple between 2011 and 2016, although more recent data indicate that the tide is turning. [iv] Another factor may be enhanced data collection and increased focus and resources that Massachusetts has dedicated to identifying opioid-related overdoses. These include: the Census of Fatal Occupational Injuries collected in conjunction and with support from the Bureau of Labor Statistics; the Fatality Assessment and Control Evaluation (FACE) program with funding support from NIOSH; and, the State Unintentional Drug Overdose Reporting System (SUDORS) with funding support from the Centers for Disease Control and Prevention (CDC). It is likely that the concerted efforts in Massachusetts identified opioid overdose cases in the workplace that might not have been otherwise identified. As such, it is likely that other states without these resources have opioid overdoses that are unrecognized as occurring in the workplace.

In Massachusetts, the 2016-2017 report, identified the following industries and occupations with high numbers of drug overdose deaths in the workplace.

• Accommodation and food service (nine deaths)
• Construction and extraction (six deaths)
• Real estate and licensing (six deaths)

A previously published report using data from death certificates from 2011-2015, found that the rate of all fatal opioid overdose in Massachusetts (not only those occurring at work) varied significantly by industry and occupation of the decedents, with construction and extraction workers having both a high rate (151 deaths per 100,000 workers) and a high number of opioid-related overdose deaths (1,096 out of 4,302 total among the total working population). In fact, the opioid-related death rate for those employed in construction and extraction occupation was six times the average rate for all Massachusetts workers (25 deaths per 100,000 workers). In addition, the rate of fatal opioid-related overdose was higher among workers employed in industries and occupations known to have high rates of work-related injuries and illnesses. This finding is consistent with previous research documenting common use of prescribed opioids for management of acute and chronic pain following work-related injury. The rate was also higher among workers in occupations with lower availability of paid sick leave and lower job security such as construction and extraction, farming, fishing, and forestry, and food preparation and serving related occupations.

NIOSH has found similar, but also unique results in national analyses including increased rates of drug overdose death at work in transportation, construction, mining, and healthcare. [iii] Additional NIOSH research has found elevated rates of drug overdose (not only those occurring at work) in construction, healthcare, and extraction (mining and oil and gas extraction).[v] NIOSH analyses have also identified differences in the type of drug implicated in the overdose by industry or occupation which is important for targeted prevention efforts.[iii,v]
 

Next Steps

Both NIOSH and Massachusetts are taking action in response to these data on drug overdose in the workplace. In Massachusetts, the state’s Department of Public Health is working with workplace health and safety stakeholders, substance addiction service providers, and policy makers to provide opioid awareness peer training for high risk worker groups and identify other additional opportunities to implement worker-oriented opioid overdose prevention strategies. Massachusetts also developed a unique research tool, called the Public Health Data Warehouse (PHD) which links over 25 statewide databases with the goal of analyzing trends in the opioid epidemic. In addition, Massachusetts is developing evaluation procedures for when a fatal workplace overdose occurs. These procedures are based on the FACE program inspection protocols. Information obtained from these evaluations will help guide development of recommendations for employers focusing on injury prevention and recovery-friendly workplaces.

NIOSH is using Total Worker Health® principles to address the opioid crisis, recognizing that the effects of drug use and misuse are not isolated to work or home environments, and the potential for drug use disorders may be preceded by injuries that happen in the workplace, with the consequences affecting both an individual’s working life as well as their home life.

NIOSH is beginning to assess issues related to Workplace Supported Recovery to assist workers and employers as they help workers in treatment for opioid use disorder, and other substance use disorders, in the return to productive, supportive employment. When completed these efforts will provide employers with evidence-based policies and programs to reduce the risk factors associated with substance misuse and the progression to a substance use disorder and take steps to assist workers who are in recovery in staying at work or returning to work. NIOSH will begin the effort by seeking input from partners through a published Federal Register Notice in early 2020.

The NIOSH Opioids in the Workplace webpage contains information and resources including: Things to consider in establishing a workplace naloxone program, and Things employers should know about medicated assisted treatment. To address gaps in knowledge in the opioid response, NIOSH has recently incorporated related research goals into its Strategic Plan for FY2019-2023.

Conclusions

The latest information from NIOSH and from Massachusetts underscores the need for educational and policy interventions targeting high-rate worker populations to prevent drug overdose deaths. Interventions should address workplace hazards that cause injuries for which opioids are prescribed, as well as appropriate pain management following injury, including safer opioid prescribing, access to evidence-based treatment for opioid use disorders, access to alternatives to opioids for the treatment of injuries and pain, and overdose prevention education.

We must not lose sight of the fact that these data represent individuals whose lives have been lost, with impacts on families, employers and society. Additional efforts to identify, describe, and monitor drug overdose deaths at work are warranted to understand the true burden and guide the response to the epidemic.

In the comment section below, please share any steps your workplace has taken to address the impacts of the drug epidemic on workers.

Dawn Castillo, MPH, is the Director of the NIOSH Division of Safety Research and Co-Chair of the NIOSH Opioids Data Framework Working Group.

Michael Fiore, MS, leads the Occupational Fatality Unit within the Occupational Health Surveillance Program at the Massachusetts Department of Public Health.

Emily Sparer-Fine, ScD, is the Director of the Occupational Health Surveillance Program at the Massachusetts Department of Public Health.

Hope M. Tiesman, PhD, is a research epidemiologist in the NIOSH Division of Safety Research and member of the NIOSH Opioids Data Framework Working Group.

Steve Wurzelbacher, PhD, is the Director of the NIOSH Center for Workers’ Compensation Studies (CWCS) and Co-Chair of the NIOSH Opioids Data Framework Working Group.

Other NIOSH Science Blogs addressing the Drug Overdose Epidemic and Workers

References

[i] Source: National Vital Statistics System, National Center for Health Statistics, 2018. https://www.cdc.gov/nchs/products/databriefs/db329.htm

[ii] Source: National Vital Statistics System, National Center for Health Statistics, 2018. https://www.cdc.gov/nchs/data/databriefs/db329_tables-508.pdf#page=4

[iii]  Tiesman HM; Konda S; Cimineri L; Castillo DN. Drug overdose deaths at work, 2011-2016. Inj Prev 2019 Nov; 25(6):577-580.

[iv] MA Department of Public Health, Data Brief: Opioid-Related Overdose Deaths among Massachusetts Residents, posted November 2019. https://www.mass.gov/doc/opioid-related-overdose-deaths-among-ma-residents-november-2019/download

[v]  Harduar Morano L, Steege AL, Luckhaupt SE. Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths — United States, 2007–2012. MMWR Morb Mortal Wkly Rep 2018;67:925–930. DOI: http://dx.doi.org/10.15585/mmwr.mm6733a3external icon.