A NIOSH Role in Prescription Drug Abuse Prevention

Posted on by John Howard, MD and Steve Wurzelbacher, PhD, CPE, ARM


*NCCI has released new data since the posting of this blog.  Recent workers’ compensation studies reveal controlled substances accounted for 29% of prescription drug costs in 2014.


Prescription drug abuse and overdoses are a major public health concern (Health, United States 2013).  The CDC reports that opioid overdose deaths in particular have quadrupled since 1999, with more than 16,600 deaths in 2010 alone. The CDC has been focused on boosting resources for State prevention efforts and the President’s FY 2015 budget request of $16 million seeks to help States expand and intensify their work to implement interventions.

Prescription drug abuse has a broad reach across all aspects of society. Workers may face unique risks as injuries sustained at work are increasingly treated with powerful prescription drugs including opioids such as OxyContin, Vicodin, and Demerol. Recent workers’ compensation studies reveal that prescription costs are continuing to rise, with narcotics accounting for 25% of costs. (Updated data available.  See note at the top of the blog.) 

NIOSH’s new Center for Workers’ Compensation Studies (CWCS) is focusing on working with partners to use workers’ compensation data to improve workplace safety and health.  The CWCS teams NIOSH researchers with colleagues in the public and private sectors to explore opportunities for leveraging workers’ compensation data to reduce the incidence of work-related injuries and illnesses.  In addition to efforts to prevent injuries and illesses, the CWCS also seeks to ensure that workers’ compensation medical care is provided in a way that minimizes the risk of opioid dependence. Many states have taken steps to control opioid use in their workers’ compensation systems by limiting opioid availability, educating health care providers on responsible opioid prescribing, and increasing awareness among injured workers.

The CWCS is encouraging state departments of health and workers’ compensation agencies to collaborate on workers’ compensation data trending and is planning future webinars to focus on recent partner opioid prevention activities. Information on grant opportunities related to the prevention of opioid abuse can be found at: http://www.grants.gov/web/grants/view-opportunity.html?oppId=253411.

Workers can access a searchable database of substance abuse programs through the Substance Abuse and Mental Health Service Administration (SAMHSA) website.  Individual employer assistance programs (EAPs) may also offer useful information.

We have included a listing of prescription drug prevention resources for health care providers as well as additional information on prescription drug abuse. If you know of additional resources, please respond with comments to this blog.

We welcome all feedback as NIOSH works with our partners to prevent the risk of opioid dependence among workers receiving workers’ compensation medical care.

John Howard, MD and  Steve Wurzelbacher, PhD, CPE, ARM

Dr. Howard is the Director of the National Institute for Occupational Safety and Health. 

Dr. Wurzelbacher is the Director of the NIOSH Center for Workers’ Compensation Studies (CWCS).

Posted on by John Howard, MD and Steve Wurzelbacher, PhD, CPE, ARM

39 comments on “A NIOSH Role in Prescription Drug Abuse Prevention”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Additional resources:

    SAMHSA Fact Sheets on Preventing Prescription Abuse in the Workplace

    SAMHSA Prescription Drug Abuse Weekly Update

    SAMHSA Prescription Drug Abuse Weekly Update Archive

    It’s really a great and useful piece of information. I am glad that you just shared this helpful info with us. Please keep us informed like this. Thank you for sharing.

    Best & informative piece of writing. Its major public health issue, Thanks for including the targeted list of drugs.It would helpful for the public health.

    Appreciate the article post here. This is something we have seen more of as well from working in substance abuse recovery with families. Keep up raising awareness.

    – Reach Recovery, Greenville, NC

    I was searching the web for updated statistics on prescription drug abuse and found this website story about prevention. I work for Drug Treatment Network in South Florida where just a few years ago pill mill doctors were on every other street block shopping center and people could pay $200 to $500 to get a script for opitates, benzo’s and other things. I was wondering how the rest of the Nation has been impacted by that? Although we still see and speak with many people with pill addiction, it seems to be fewer people, but more are on heroin and meth. I’m seeing conflicting stories all over the web, does any government affiliation know or have updated stats?

    Drug Treatment Network

    Here are some recent CDC publications that include drug overdose burden information. The last link is to a recent publication on the promising initial impacts of Florida’s policy changes to address opioid abuse.

    This article is efficient. Thank you for sharing it with us. I am visiting this blog on a daily basis and I am finding so much helpful article each time. Keep working on this and thank you once again.

    I am very happy to read this. This is the type of manual that needs to be given and not the accidental misinformation that is at the other blogs. Appreciate your sharing this greatest doc.

    Great article with a ton of info. There are clinical tools designed to stratify risk with patients in pain management. One of the major one’s is called the Opioid Risk Tool (ORT), which defines risk of becoming addicted to opiates based on historical and clinical factors.

    This article is of great importance to national and cultural level, since many people are falling into addiction by not having a responsible use of medicines, not to receive information about or receive good advice when taking any prescription medica. So I think it is vital to keep well informed and prevented workers against any disease or treatment, and even facilitate a website or a phone so they can contact in case of doubts.

    Thank you very much for the info, really are very useful these items aimed only the good of the population.

    This article has given me an awareness and insight into prescription drug abuse, it is not a topic of discussion in my country, it maybe a lack of awareness, statistics or underreporting. I believe that the whole world is a village and what affects one eventually will affect the other. This article will helps us to remain vigilant to the overuse of prescription drugs in our society

    Great article with a ton of info. There are clinical tools designed to stratify risk with patients in pain management.

    Hopefully these programs will address the underlying emotional causes of opioid addiction at a 1-2-1 level, usually missing from most programs. Especially needed here are additional fully residential programs that remove the individual from triggers and association that normally set the pattern of addiction into flow. Thanks

    Increasing information on prescription drug abuse to help prevent risk is valuable. Everyone will benefit when employers, workers and healthcare providers become more knowledgeable.

    The National Safety Council thanks NOISH for drawing attention to this important issue. Prescription painkiller misuse impacts employers and workers far more than many realize. NSC has published the report, Prescription Pain Medications: A Fatal Cure for Injured Workers which examines court decisions in which injured workers died of an overdose from pain medications prescribed to treat their workplace injury. The report recommends employers take measures that protect their injured employees while decreasing their liability. The report can also be downloaded at http://nsc.org/workerscomp.

    WorkCompCentral published in June 22 my narrative of opioid use in workers comp, tracing the widening use of opioids from the 1990s through the many responses by state and private sector parties to contain the use of opioids, through today in 2015. I include in the report some provocative recommendations for closer collaboration to support conservative treatment of chronic pain among injured worker.

    the report: We’re Beating Back Opioids — Now What?

    Increasing information on prescription drug abuse to help prevent risk is valuable. Everyone will benefit when employers, workers and healthcare providers become more knowledgeable.

    The California Division of Workers’ Compensation is engaged in a number of collaborative activities with our health department (CDPH) and other agencies including:
    • Participating as a member of the Interagency Prescription Opioid Misuse and Overdose Prevention Workgroup (chaired by CDPH) http://www.cdph.ca.gov/Pages/OpioidMisuseWorkgroup.aspx
    • Supporting CDPH in a number activities, geared towards tracking prescription drug misuse and related educational efforts
    • Collaborating with the Medical Board of California by participating and speaking at the MBC’s Prescribing Task Force Meetings and ensuring that our respective guidelines are consistent http://www.mbc.ca.gov/About_Us/Meetings/2015/Agendas/agenda_20150413_rx.pdf. Webcast available at: http://www.mbc.ca.gov/About_Us/Meetings/2015/
    • We just released for rulemaking and public comment new medical treatment guidelines for chronic pain and for opioid use for non-cancer pain in the work comp system. Here is the link to the rulemaking page: http://www.dir.ca.gov/dwc/DWCPropRegs/MTUS-Opioids-ChronicPain/MTUS-Opioids-ChronicPain.htm. A public hearing will be held on September 1, 2015.
    • We plan to develop and disseminate online CME modules to educate physicians and other providers about pain management and opioid use for management of non-cancer pain.

    I use drugs such as hydrocodone. Without using them, I have pain literally all over my body from severe Arthritis. All of my joints are in pain at one time or the other.

    But, instead of prescribing these medications, which the FDA is trying to totally ban, I am offered Physical Therapy and a localized shot to kill the pain in 1 Joint.

    Physical Therapy is roughly 10 times more expensive than a bottle of 30 Pills, which I can not afford, even after my Medicare takes care of the first 80% of its cost.

    Why is the FDA and the CDC trying to penalize me? It is not my fault some doctors are over-prescribing these Pills. I WAS only using them when I absolutely needed them.

    I am now using Tramadol. So far they seem to be fairly effective, bringing my pain down to roughly #4 Level. But, for how long? How long will it be before I need much stronger medications?

    I take a very hot bath at least once a day, sometimes twice a day to control my Pain. It is helpful, but only partly. And, I can not soak my entire body due to the small Bath Tub.

    You are applying a Blanket Decisions on ALL Patients who desperately need these medications, many who do not abuse the medication’s use.

    What do I need to do, break the law and get the needed medication I so badly need? I don’t want to. But, I definitely will if I need to.

    If you want to Penalize anyone, penalize these Greedy Bastard Doctors that Over-Prescribe these medications for Profit, not the Patient that needs the medication and will use them legally and wisely to control their Pain.

    Please restore the Patient’s use of these medications. We desperately need them. I know I need them badly.

    IF anyone wishes to contact me directly, I will happily discuss my situation.

    Thank You,


    Thank you for your comment. Many people are like you have a compelling medical need for opiate pain relievers to control chronic pain which otherwise would be incapacitating. You are exactly right that the real issue concerns inappropriate, or non-indicated use of opiates, also referred to as “overprescribing.” As you say, opiates have an important role to play in chronic pain conditions like yours. NIOSH is interested in raising awareness that often a workplace injury is the initiating reason for use of an opiate to control acute pain. If we can prevent those types of injuries, we can help reduce the need for opiates altogether.

    I am a chronic pain sufferer diagnosed with multiple debilitating and painful diseases, my use of opiod medication has literally saved my life mentally and physically for without them I would not be able to to get out of bed to care for myself or my loved ones which equals 0 quality of life for me. I understand some education and some non invasive monitoring is needed to provide the best treatment scenario but when does it become a violation of my rights to have the government tracking my every move as if I am a drug addict slash dealer the demeaning way some providers handle the situation is a power trip. When did the common people who founded this country lose.their voice to government . I have also noticed who fights for my rights as a chronic pain sufferer didnt that used to be the Primary Care doctor now they are so afraid of the government spying and controlling them they have lost the desire to help the patient when they took the hypocratic oath it seems to no longer matter. Give people like me a fighting chance it seems that your punishing everyone with no transparency to the public. Go out and talk to people like me who suffer every day with debilitating pain and add that to your statistics I believe you would see and evening out of the scales good and bad. Don’t be so one sided show the hope that monitored opiod use can provide.

    Thank you for your comment. You are right that there needs to be a balance between safeguarding physicians’ appropriate use of opioids for chronic pain relief from conditions like yours, and, on the other hand, inappropriate or careless prescribing that can lead to opioid addiction not linked to pain relief.

    An important link in the article is now broken. I wonder if it could be fixed or if the page it went to simply doesn’t exist any more. I’d like to see the document from which the 25% statistic came, to see what time period it refers to.

    “Recent workers’ compensation studies reveal that prescription costs are continuing to rise, with narcotics accounting for 25% of costs.” (end of second paragraph, the link to the pdf of these studies).


    Thank you for your interest and for pointing out the broken link. It is now fixed. We have also indicated in the blog that NCCI has new data available. Recent workers’ compensation studies reveal controlled substances accounted for 29% of prescription drug costs in 2014. Note that NCCI has changed from using the term “narcotics” to “controlled substances” which are defined as “prescription drugs classified as Schedule II and III by the Drug Enforcement Administration (DEA).

    So many addicts get hooked after an injury, anything the NIOSH can do to curb the upward trend of opiod addiction statistics is a step in the right direction.

    Indeed, that is the case—a workplace injury often is the antecedent cause leading to overuse of prescription opioids. Thanks for your support.

    I was very thankful! I really glad that there is a blog like this that`s was sharing. Thank you for your pointed medication information it really can help me at sites.

    Increasing information on prescription drug abuse to help prevent risk is valuable. Everyone will benefit when employers, workers and healthcare providers become more knowledgeable.

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