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The Opioid Overdose Epidemic and the Workplace

Posted on by Dawn Castillo, MPH and John Howard, MD

 

Last week, the Centers for Disease Control and Prevention released troubling statistics on the growing epidemic of drug and opioid overdose deaths in the United States.  The origins of this epidemic have been linked to prescription opioids.  While it is unknown how many drug and opioid overdose deaths are associated with workplace injuries and illnesses, it is clear that this national epidemic is impacting workers and employers.

A May 2014 NIOSH blog noted that injured workers are frequently treated with powerful prescription drugs. The blog reported on studies demonstrating that narcotics account for 25% of prescription costs in workers’ compensation systems and that those costs are rising.

An important avenue for combating prescription drug abuse are guidelines that health care providers can use to offer safer and more effective pain treatment. NIOSH’s sister agency at the Centers for Disease Control and Prevention, the National Center for Injury Prevention and Control (NCIPC), has released draft opioid prescribing guidelines and has invited public comment through January 13, 2016.  NIOSH invites interested stakeholders to provide input on the draft CDC opioid prescribing guidelines.  Comments need to be submitted directly to http://www.regulations.gov/#!documentDetail;D=CDC-2015-0112-0001.

In addition to work injuries and illnesses being the reason opioids are prescribed in the first place, there are others ways in which this epidemic is undoubtedly impacting workers and employers.  The use of prescription opioids may impact the ability of a person to return to work, and ultimately can negatively affect their livelihood.  If workers are under the influence of opioids while they are at work, they are likely to be at increased risk for injury.  For workers in safety sensitive jobs, such as transportation and operators of heavy equipment, there will be increased risks for catastrophic events that impact many besides the worker.

NIOSH remains committed to primary prevention of occupational injuries and illnesses as our primary focus. We recognize the impact of the current opioid overdose epidemic on the workplace, and have compiled resources that may be useful for workers, employers, health care providers, and other stakeholders on a new topic page.  We also believe that the NIOSH Center for Workers’ Compensation Studies provides a venue for research that can help inform interventions through workers’ compensation systems.

NIOSH welcomes suggestions for additional resources that we might include on our Prescription Drug Overdose Prevention webpage and relevant research that might be addressed through the NIOSH Centers for Workers’ Compensation Studies.  For example, the CDC Pocket Guide: Tapering Opioids for Chronic Pain.

Each individual patient’s clinical situation is different and the need for pain relief should be individualized. This blog is about the contribution that workplace injuries plays in opioid use. In order to focus this blog discussion we will only post comments that are relevant to the opioid issue in the workplace. (added 12/12/16)

Dawn Castillo, MPH, is the Director of the NIOSH Division of Safety Research.

John Howard, MD, is the Director of the  National Institute for Occupational Safety and Health.

 

Posted on by Dawn Castillo, MPH and John Howard, MD

34 comments on “The Opioid Overdose Epidemic and the Workplace”

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 ».

    This ties in to the 60 Minutes episode with the new drug czar Michael Botticelli. They said how many pain drugs are opioids, like heroin. And the number of opioid prescriptions has risen from 76 million in 1991 to 207 million today. It is going to take reduction in prescriptions to help solve this problem. Best Scott

    Thanks for your comment, Scott. Indeed, as you say, prescribing practices will have to change. CDC’s prescribing guidelines are a start in that direction. Many states also have prescribing guidelines. For example, the Medical Board of California published in 2014 Guidelines for Prescribing Controlled Substances for Pain which can be found at http://www.mbc.ca.gov/licensees/prescribing/pain_guidelines.pdf

    The US prescribes way too much, many people go on to use heroin. More needs to be done at the federal level, there is not near enough need for all the pain medication as the big pharmaceutical companies would like you to believe. This map shows just a small portion of people lost and their stories contributed by family members due to this problem http://storymaps.esri.com/templates/shortlist/?webmap=61031a7605d7445399cc58993118bd0d&DETAILS_PANEL=true

    More maps on the epidemic are here https://www.linkedin.com/pulse/mapping-prescription-drug-heroin-epidemic-jeremiah-lindemann?forceNoSplash=true

    Jeremiah:

    Thank you very much for your comments and especially for sharing the story map Internet site about those who have been lost to opioids. What a powerful site. I was struck by how young everyone pictured there was when they died from opioids. Thank you also for sharing the map site. Both of these sites are visual reminders of the human cost of the opioid epidemic.

    Thank you.

    Communication and education are key components in combating the crisis of opioid abuse and addiction. Unfortunately far too many people are struggling to overcome their drug addictions and seeking recovery because of the overuse of prescription pain medications.

    Thank you for your comment. As you say, communication and education are key. Educating everyone about the dangers of overuse may help stem the tide of opioid addiction.

    How is it that you do not find here comments from people who actually live in excruciating pain, and there are people who live every day with conditions other than Cancer that are beyond pain description. How about compressed spinal cord, multiple surgeries, getting a throat cut open to put in plates after the bone itself could not be fully removed from jabbing the spinal cord and the forminal areas, then having it done again and again, and the lumbar surgeries, and the instability and intense pain shooting till a person wants to scream, total of several surgeries and still incredible indescribable pain. Do you think perhaps a broad brush is fine if you are not going through this, but perhaps not fair to people who do go through this? Some of us don’t want to go with the new industry, the so called cure all, smoking the plant material. It is bad for short term thinking, and who knows what else. You do not know me but I do a lot of precision research. Get all points, not just the point of an outsider condemning everyone. Please try seeing this from the point of people living in incredible pain, who see multiple doctors, who have MRI’s and other proofs of damage.

    Thank you for comment noting that there are sound medical indications for prescription opioid use. Rather than the medical indications that you point to, nonmedical prescription-opioid use, and its relationship to the increase in heroin use, is troubling. As the blog points out, workplace injuries may serve as the starting point in the linkage between nonmedical use of prescription opioids and heroin use. Prevention efforts that aim to reduce the rates of nonmedical use and overdose, while maintaining access to prescription opioids, is the sought after solution. Thanks again for your comments.

    Bill – thank you for voicing your concern on the conversation here, working in the occupational health field I thought that this article would have some interesting information. What I found was cause for more consternation.
    We need more education for everyone about pain; how being in pain slows healing and damages the brain, mental health and relationships. If we allow our injured workers to go without the correct pain support during their recuperation we will be setting ourselves up for failure in other areas.
    To say broad statements such as ‘too much’ and ‘many’ are not quantifiable. Perhaps we should start with collecting some data for analysis and then make decisions based on the verifiable findings.

    It would be nice if those that make the rules we peons must live by could experience a few months of chronic pain from arthritis and degenerative disc disease, aggravated by physical injury to the already weakened discs.

    It would also be good if they could encounter a pharmacist, empowered by new regulations and company procedures, who doesn’t think you look like you need the amount of painkiller your doctor gives you, and does everything within her power to make your life more difficult and stressful.

    Easy answer? Go to a different pharmacy.
    Good luck with that. If you’re not “established” with a pharmacy, they don’t want to see a prescription for oxycodone or drugs in the same class. Additionally, none of them want to go through the hassle of the paperwork necessary to increase their allotment of the drug, only to have it refused.

    I’ve been going to the same doctor, and same pharmacy for years. I still get a pain in my gut every time I pull up to the drive-in window with my monthly prescriptions.
    Will they have it in stock?
    Will they fill it, or come up with some BS reason to delay or deny it?

    I’m having spinal fusion surgery next week that I probably would not choose to do at this time, were it not for the hassle of getting the prescription painkillers I need.
    I pray that things will go well, and my pain level will be reduced to a level I can manage without narcotics.
    I don’t have many other options…the stent in my coronary artery precludes the use of NSAIDs.

    Thanks for your comments and insights about chronic pain and the value of opioids for relieving that pain. Achieving a balance between use and abuse of opioid medications is a delicate one.

    I read an article that was published in a New York paper last year on the topic of how opioid overuse has led to an epidemic of heroin addiction.
    The blame for this was laid at the feet of the pharmaceutical companies for promoting the use of opioids, and breaking down the long-held belief that opioids equal addiction.

    The example used in the article was of a teenage girl who became dependent on oxy after stealing pills for recreational use from her aunt, who was stealing them from the pharmacy she worked for.

    When the aunt was fired from her job, the teen’s source was gone. She then found that it was much cheaper to buy heroin on the street than oxy, and in short order, was addicted to heroin.

    But somehow, this was all Big Pharma’s fault…

    After reading that article, I couldn’t help wondering if the groundwork was being laid for a government lawsuit against Big Pharma, and news outlets were being fed, or encouraged to find stories that would sway public opinion to support such a move.
    Just think of the possibilities…there are billions of dollars there for the taking…and who would it hurt? Just some already rich stockholders?

    No, it would hurt everyone who buys prescription medicines, including the government, by driving up the cost of medications.

    The article did not differentiate between physical dependence and addiction.
    I was shocked to find that many medical professionals are not aware of the difference, and consider physical dependence to be addiction.

    Dawn, I would like to thank you, Dr. Howard and your staff for the article on this important opioid research. I have shared this information with every construction organization I work with. As you know opioids are a major problem within the construction industry.

    Thank you.

    Make a Difference Today

    Carl W. Heinlein, CSP, ARM, CRIS
    Senior Safety Consultant
    American Contractors Insurance Group
    7500 Brooktree Drive
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    Wexford, PA 15090
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    Carl: Thanks for your efforts to raise awareness about the opioid overdose epidemic and connections to the workplace with your colleagues in the construction industry.

    Thank you for the great info! I would like to share this with my state occupational health nursing association but wondered if you could clarify something first.

    “The use of prescription opioids may impact the ability of a person to return to work, and ultimately can negatively affect their livelihood” Could you share what is meant by this statement?

    Also, the American College of Occupational and Environmental Medicine has published guidelines for chronic use of opioids. It is part of a larger clinical guidelines document available on the ACOEM website.

    Thank you for your comment.

    The use of opioids can often lead to extended use or even overuse beyond what was prescribed. In addition to their intended effect in providing pain relief, opioids can impair a worker’s ability to perform their job at their usual high level. Return to work can be delayed and sometimes loss of employment can be the end result. Thank you also for noting the ACOEM guidelines.

    The present opioid prescription guideline does NOT address those persons, such as myself, who have fibromyalgia and severe arthritis. I need the when the allowable dosage, by this guideline, runs out, as prescribed by my doctor, who is and expert, to control the chronic pain from these afflictions. Today my doctor had to reduce the dosages in order to comply with this new Guideline. This puts me in a severe state of pain when the medication runs out. The guideline suggests, according to my insurance, that I use Tylenol. Totally ridiculous. Obviously none of you, who put forth these Guidelines, have ever experienced chronic pain.
    When will you people EVER put forth guidelines for pain medications, that is relevant to those who suffer?
    I believe that chronic pain, as caused by illnesses, such as fibromyalgia, will suffer by “Guidelines” that are NOT taking suffers’ problems into account, but who would just pander to the wiles of special interest groups. GET REAL.

    Thank you for your comment. Chronic pain from fibromyalgia and severe arthritis are both painful conditions where pain management is important. The CDC recommendations for prescribing opioids for chronic pain outside of active cancer, palliative, and end-of-life care are not mandatory for physicians. They are guidelines or suggestions to help physicians make good decisions about chronic pain management. As you say, pain management is very relevant to those who suffer painful conditions. I am sure your physician has evaluated both the benefits and the risks of using opioids to alleviate the pain arising from your conditions.

    This epidemic is troubling and seems to have grown significantly from the statistics released. It seems that even small factors are causing a problem. There is an interesting article written about how the opioids prescribed by dentists are now starting to take effect and play a huge role in the number of individuals addicted to painkillers.

    You can read the article here:
    http://www.drugtreatmentcenterfinder.com/dentist-dealers-opioid-addiction-bites-back/

    I hope to see another article about this in the future from CDC.

    Thank you for your comment, and thank you for the link to the interesting article on opioid prescribing in the dental environment.

    John & Dawn,

    I hope that these guidelines not only reduce the amount of prescriptions written, but also decrease the length of said prescription. A major factor that contributes to substance abuse and addiction is the prescribing of painkillers over long periods of time. After a period of time, users may feel that the current prescription is no longer producing the wanted results, so they go to up the doasge of their prescription. They may or may not be denied. In this case, if the prescription is prescribed for a higher dosage the doctors are enabling the abuse of the substance (because painkillers are not meant to be taken over lengthy time periods), if the preacription is not changed and instead is stopped, there is a likely chance that the individual will look for relief elsewhere – either from another doctor, or from illicit drugs.

    I recently came across an article that discussed the possibility of CVS to sell Narcan without a prescription – they’ve previously sold Naloxone in MA and RI. From what I’ve read, it seems that Narcan is a non-addictive, non-toxic prescription medication that stops the effects of opiates/opioids. It seems that this attempt is to allow the purchase of the medication without a prescription in hopes to make it readily available in an emergency situation (i.e. someone you know overdoses). What are your views on this?

    This is the article I am referencing: http://www.recoveryhub.com/cvs-sell-narcan-without-prescription/

    Thank you for your comments about the over-the-counter (OTC) availability of Naloxone (Narcan). A number of states have shown that providing naloxone kits to laypersons reduces overdose deaths, is safe, and is cost-effective. See http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6423a2.htm. A majority of states have now passed laws making Narcan available for OTC purchase. For a list of states, see http://choopersguide.com/content/naloxone-laws-by-state-map.html. Used in an emergency situation, Narcan can be a life saver, but it is not a cure for opioid addiction.

    I am disabled with multiple chronic progression of degenerative disk disease. I had been taking the same dose of OxyContin for the past 11 years! My dose had not changed until the CDC published their 2 cents worth of knowledge in March of 2015. My doctor had a medical tech tell me (she could not do it herself; violating one of my patient rights…and violating the 5th vital sign of pain assessment…) that my dosage would blindly be cut by 20 mgs per script until…” I would no longer on any pain medication” despite the fact that my entire spine was riddled with 10 herniated non-surgical disks (from cervical to lumbar) ; congenital defects, multiple morphologic abnormalities as per my MRI’s . I was NOT allowed to speak to my attending doctor until I scheduled an appointment 1 month later to discuss pain control! My original family doctor retired and his practice was purchased from a doctor recently licensed in the US from the middle east. Even though this new middle eastern MD prescribed my opioid pain medication without a problem for almost 2 years while the transition of care occurred from my old doctor to the new doctor; I was being discriminated for being disabled that required opioid pain management for palliative care! Do not tell me that opioids do not work for extended length of time because I was on the same dose for about 11 years without any problems!! In fact, the side effects quieted down the first year or two and the medicine seemed to relieve my pain without any problems such as needing to increase the dose. I did not experience the “euphoric high” or any of the other side/adverse effects once I had been on this particular med. While taking this medication, my quality of life was as good as it could get and I was able to function (participating in life with my grandchildren) and do things that I can no longer do since I was taken off of it. I can no longer shower daily because my pain complicates my ability to do ADL’s. I can no longer run simple errands at the grocery store. I have to try to beg others to do these tasks for me. I can not stand at the sink to wash dishes or cook simple meals without having to go lay down because of the back pain. I have to spend a lot of time in bed because no one cares that my quality of life has dropped so drastically nor does anyone care that my level of functioning has even impacted my genetic lung disease causing a decrease in my pulmonary function by at least 5% over the past 4 months. I have gain weight due to lack of mobility (about 15 lbs or more). I suffer daily knowing that I will not have pain control even though my goal (on a scale of 1-10 is “5 or 6”). I can no longer sleep during the night because the pain wakes me up. I have told these things to my family doctor and pain specialists. The lowest rating my pain is maybe a “7” on a good day and at rest but usually it is between 8-10+++! I have no dignity because I feel degraded by those that are suppose to be helping since my pain medicine was OxyContin and I require pain management. I do not want anymore steroid injections or any other surgical intervention; besides , I have been told I have too many problems to do any type of surgery. My end stage genetic lung disease also prohibits any possible surgical intervention. Some days it is so difficult to suffer with ongoing back pain and try to push through the pain because I want to spend holidays with my family or just spend time with my grandchildren. Even though I have not sought any legal action towards any of my doctors, I am interested in doing so. The medical profession is like any other business, the doctors want to do procedures to generate revenue and if that goes against what the patient wants…well then the patient must be seeking drugs! I just want to live the best life I can and some say in deciding my care. I would be happy with a goal of 5_6 or 7 on a pain scale but thanks to these new guidelines; it has just made my life hell. Not everyone every one who needs opioid pain management should be lumped into in to a single category, “drug seeker”. Yeah, I’m ashamed for these so called “professionals”! What ever happened to patient rights? Civil rights for the disabled? Or palliative care??

    Opiate abuse after an injury of any kind is so common, employers are smart to recognize it and try to mitigate the problem at the beginning of an injury and reducing workplace injuries altogether.

    Thank you for your comment. Early intervention to prevent opioid dependence is always a good strategy.

    19 years ago I had L5 part like the Red Sea so to speak. After PT, Stim treatments, 3 unsuccessful surgeries, epi’s at lumbar and cervical (now have degen spine issues at all levels), have never asked for higher doses, never “lost” a script”, have been told time after time “I was the model patient” (seen 2X a year by pain clinic at local hospital for over 15 years without a red flag), only uninterrupted sleep since the initial event was while in a coma for 9 days in 2009 (best sleep in years!) due to heart attack and dump of excess fluid into lungs, always followed the rules and now I am treated like a criminal. Out of the blue the hospital decided to close the pain clinic (4-6 clients max at any one time) due to “an event” which they would not disclose to the physician which I have seen for close to 10 years (prior senior physician in clinic had retired). He was embarrassed and could not understand why the decision was made other than perhaps the health system/hospital/physician group did not wish any liability. I received the same answer from my primary care physician who was “ordered” to take me off of a complementary drug to control spasms and side effects of another medical condition (menieres). Once again after a very long relationship without any red flags I found myself at the mercy of a world gone mad. The only explanation he had was an example of a young man/toddler that got into parent’s meds with tragic results and supposedly a $30MM judgment was awarded. I practice safe storage with the meds in question under lock and key except for daily dosage which is set up each morning, have not touched even just a beer in coming up on 2 decades since I understand the implications. Has my body build a tolerance? Yep. Have I asked for adjustment to dosage? NO. I live at a “6”, lost the ability to travel, play sports, hike, ride horses and the list goes on and on. Now everyone want to lower a dose which has been tolerated without issues for a very long time. Quite frankly if I have to live at an 8 my heart will most likely just give out (It is telling when one’s vascular surgeon in a conversation with one’s cardiologist is surprised that I am still living; this conversation took place ~6 months ago just to put perspective on CHF status (stage 4). Now I am simply thrown into a box with everyone else which is not what medicine is in theory all about. The hippocratic oath has become the”hypocritic” oath it appears. What a wonderful world we live in to steal a line from a well known movie. /steps down from soapbox.

    Thanks for adding to the discussion about opioids and the effect the current issues regarding opioid overuse and frank abuse is having on patients like yourself who have a strong medical indication of the use of opioids and are managing their use appropriately.

    I am interested in finding out how many unintentional opioid related overdose deaths occurred from 2012-2016 for those persons who worked in the coal mining industry? Can you point me in the right direction?

    Thanks for your question regarding unintentional opioid related overdose deaths in the coal mining industry. I am not aware of a current data source for the occupation/industry level for opioid overdoses. However, CDC has quite a bit of information on opioid overdoses. See https://www.cdc.gov/drugoverdose/opioids/index.html and a nice YouTube video at https://www.youtube.com/watch?v=3VnXk2FAwW4. There is also a recent article in the New York Times that you might also be interested in
    https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html

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