Injured Workers More Likely to Die from Suicide or Opioid Overdose

Posted on by Katie M. Applebaum, ScD; Abay Asfaw, PhD; Paul K. O’Leary, PhD; Andrew Busey, BS; Yorghos Tripodis, PhD; and Leslie I. Boden, PhD

Drug overdoses and suicides have been rising since 2000 and are major contributors to a recent decline in US life expectancy. The opioid crisis is largely to blame, with a record 47,600 overdose deaths in 2017.[1] Suicide rates in 2016 have increased 30% from 1999.[2] Case and Deaton have called these “deaths of despair.”[3]

In the study, “Suicide and drug‐related mortality following occupational injury,” published in the American Journal of Industrial Medicine, researchers found that workplace injury significantly raises a person’s risk of suicide or overdose death. Earlier studies have shown that injured workers have elevated rates opioid use and depression. In fact, depression is among the most well-documented health consequences of workplace injury.[4] [5] [6] However, no studies have measured increased deaths related to opioid use and depression among injured workers.

Injured workers often receive powerful prescription pain medication, including opioids. In one study, 42% of workers with back injuries were prescribed opioids within a year after injury.[7] Approximately 16% of those prescribed opioids continued taking them for four quarters, with doses increasing substantially over time.

The present NIOSH-supported study linked New Mexico workers’ compensation data for 100,806 workers injured in 1994 through 2000 with Social Security Administration earnings and mortality data through 2013 and National Death Index cause of death data. Among women, lost‐time injuries were associated with a near tripling in the risk of drug‐related deaths and a 92% increase in the risk of deaths from suicide. For men, a lost‐time injury was associated with a 72% increased risk of suicide and a 29% increase in the risk of drug‐related death, although the increase in drug‐related death was not statistically significant. Risks were elevated for alcohol‐related deaths and lost-time injuries for both men and women but were not statistically significant. The only other statistically significant association between lost‐time injuries and elevated death rates was for circulatory system diseases among men.

The data presented in this paper could underestimate the problem, as there are limitations in classifying multidrug use on death certificates. In addition, misclassification of drug‐related deaths and suicides can occur when cause of death coding does not incorporate findings from medical examiners and coroners.[8] The study authors did not have information on pre-injury opioid use or depression, which could potentially affect the results. Still, the authors conclude that hazardous working conditions are one aspect of the structural causes of high mortality rates from drugs and suicide.

We are beginning to see a link between work injury, opioids, addiction, and suicide. As the nation works to address the opioid crisis, improved working conditions, improved pain treatment, better treatment of substance use disorders, and treatment of post-injury depression may substantially reduce deaths following workplace injuries.

Has your workplace taken action or increased communication about opioid addiction or suicide? If so, please share with us in the comment section below.


Katie M. Applebaum, ScD, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University

Abay Asfaw, PhD, Economic Research and Support Office, National Institute for Occupational Safety and Health

Paul K. O’Leary, PhD, Office of Retirement and Disability Policy, US Social Security Administration

Andrew Busey, BS, Department of Economics, Boston University

Yorghos Tripodis, PhD, Department of Biostatistics, Boston University School of Public Health

Leslie I. Boden, PhD, Department of Environmental Health, Boston University School of Public Health




[1] CDC [2018a]. Drug overdose deaths. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

[2] Hedegaard H, Curtin S, Warner M. Suicide rates in the United States continue to increase. NCHS Data Brief. 2018;309:1‐8.

[3] Case A, Deaton A. Mortality and morbidity in the 21st century. Brookings Pap Econ Act. 2017;2017:397‐476.

[4] Asfaw A, Souza K. Incidence and cost of depression after occupational injury. J Occup Environ Med. 2012;54(9):1086‐1091.

[5] Kim J. Depression as a psychosocial consequence of occupational injury in the US working population: findings from the medical expenditure panel survey. BMC Public Health. 2013;13(1):303.

[6] Dersh J, Mayer T, Theodore BR, Polatin P, Gatchel RJ. Do psychiatric disorders first appear preinjury or postinjury in chronic disabling occupational spinal disorders? Spine. 2007;32(9):1045‐1051.

[7] Franklin GM, Rahman EA, Turner JA, Daniell WE, Fulton‐Kehoe D. Opioid use for chronic low back pain: a prospective, population‐based study among injured workers in Washington state, 2002‐2005. Clin J Pain. 2009;25(9):743‐751.

[8] Rockett IR, Hobbs G, De Leo D, et al. Suicide and unintentional poisoning mortality trends in the United States, 1987‐2006: two unrelated phenomena? BMC Public Health. 2010;10(1):705.

Posted on by Katie M. Applebaum, ScD; Abay Asfaw, PhD; Paul K. O’Leary, PhD; Andrew Busey, BS; Yorghos Tripodis, PhD; and Leslie I. Boden, PhD

14 comments on “Injured Workers More Likely to Die from Suicide or Opioid Overdose”

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    Congratulations to the authors and researchers for this work product.

    Does your research stratify the populations by employment type, e.g., first responders (fire/EMS, law enforcement)? If yes, Is the first-responder-specific results available for review?

    Thank You,

    Leslie Boden, Katie Applebaum, Abay Asfaw, Paul O’Leary, Andrew Busey, and Yorghos Tripodis says:

    Thank you. That’s a great question. We wish we knew the occupation of the workers in this study. Unfortunately, we do not, so we can’t look specifically at first responders.

    Great study. Congratulations. I have few queries:
    1. These are only accepted time-loss claims as I doubt you would have access to other claims data or denied claims?
    2. Did you differentiate between long and short acting opioids?
    3. Did you take into account their other major life events that might have impact?

    Leslie Boden, Katie Applebaum, Abay Asfaw, Paul O’Leary, Andrew Busey, and Yorghos Tripodis says:

    Thank you. You have asked some good questions. Here are our responses:
    1. Correct. However, even with access to denied claims, it is not clear how we could use them. We would not know whether they were work-related.
    2. Our data did not differentiate between long and short acting opioids, so we could not differentiate between them.
    3. We also did not have information on other major life events.
    It would have been great to have more detailed life history and medical histories, but we did not.

    Thank you for sharing this important life-saving information, which we must take seriously to preserve the precious lives and families in our communities lest our states and nation disintegrate from within. As the surviving son of a deceased mother who was a drug addict and alcoholic, she having struggled with rejection due to having been adopted, I can attest to and confirm the fact that emotional well-being, substance abuse and suicide often are intertwined and inescapable until the person finds peace and mental health within. Ultimately prior to the act of suicide, inwardly the depressed person is dying daily and feels powerless waiting for help and the words of hope and life from somebody to enable them to see the light and transcend their darkness.

    Thank for your post sharing with us. Really it’s a very helpful post. Hope everybody will be benefited from your post.

    Ultimately prior to the act of suicide, inwardly the depressed person is dying daily and feels powerless waiting for help and the words of hope and life from somebody to enable them to see the light and transcend their darkness.

    Depression is a huge factor in compensation cases. After fighting for two years, and three knee surgeries later, my doctor has been fighting for my continued pt and is being ignored as well as my attorney…I’m more then depressed and still broken, physically and now mentally! All I want is to be fixed and the continuing issues addressed and compensation is a mind game where everyone is just a number, not an actual life! So depressing if it wasn’t for a very supportive family unit and my faith in god I would not still be here, fighting for what is right!

    Injured workers face a higher rate of depression and suicide due to the mere fact that workers compensation laws benefit insurance companies, not injured workers.
    Do you have any idea what it feels like to almost die at work, be denied medical treatment and pay and gave potential homelessness due to it?
    It’s a living torture.
    The workers compensation system needs reform NOW

    I am going through this process for 2 years now, starting from the beginning of the pandemic. The financial toll has been staggering. The loss of wages has come close to 25k, any plans you had whether yearly, 5 year or ten year, must start again. I was injured based on direction from our “lead safety tech” and have been on my own with lawyers and insurance carriers since the 3rd week. Employers only care to get you back working as fast as they can to make them money again. The longer it takes you to heal or even find the correct procedure, or even have a pandemic stop all surgeries, only costs you a portion of your life that you will NEVER get back. The depression sinks in when you have children and realize all of the things you’ve missed because of these laws, which protect employers more than the injured employee. You only see the tragedy when it’s something you go through so everyone else thinks these laws are great when they are far from it. Suicides during the pandemic are up, depression and anxiety as well but NO ONE cares.

    I herniated my L-5 -S-1 disc while working Irrigation in ma. 7 years later I’m disabled from lack of payment for my recovery and after 5 appeals to DIA court I was finally told by the judge ” I got stuck in a Broken system and 80% are faking and 20% like me has their life ruined through corruption to weed out the fakers ” maybe go after fraud instead of ruining real workers. I refuse to collect disability and still currently work 5 days a week within my restrictions in order to not loose the pathetic medical coverage I “won” but this state has no snow blow drivers because of Massachusetts corruption as I use to plow snow and install irrigation systems, after ” falling through the cracks” I work minimum wage and suffer painfully every day while this state rewards fraud and corrupt insurance companies such as Main st America

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Page last reviewed: August 8, 2019
Page last updated: August 8, 2019