Preventing Opioid Overdose Deaths in the Workplace

Today is International Overdose Awareness Day. Overdose deaths involving opioids continue to be a serious health issue in the United States. A concerning increase in drug overdose deaths coincided with the COVID-19 pandemic. Workplaces are certainly not immune from this crisis. Read on for more information on opioids in the workplace and the importance of a workplace naloxone program to reverse opioid overdoses.

Background

The United States saw a record number of drug-involved deaths in 2020. The total exceeded 93,000, up nearly 30 percent from the previous year. This death toll translates to 250 lives lost every day of the year to drug overdose.[1] In the early months of the COVID-19 pandemic, opioids were involved in around 75% of all overdose deaths [2] and some states reported an increase in opioid deaths as high as 98%.[3]  These increases could be attributed to many factors including the stress and uncertainty related to the pandemic. Workers face additional stressors including job uncertainty, fear of job loss, and reduction in income as reported in a recent NIOSH Science Blog: The COVID-19 Pandemic and the Opioid Overdose Epidemic: A Perfect Storm for Workers?

Workplaces are at risk of overdose deaths

An overdose can happen anywhere including the workplace. Unintentional overdose deaths at work from non-medical use of drugs or alcohol increased for the seventh year in a row in 2019.[4] Workplace unintentional overdose deaths accounted for 5.8% of occupational injury deaths that year.[5] Based on a survey conducted by the National Safety Council, 75% of employers report that opioid use has impacted their workplace, with 31% reporting an overdose, arrest, near miss or injury due to opioid use.[6] A recent study reported that workplace injuries that result in lost time may raise a worker’s risk of suicide or overdose death.[7] Workers who experience painful workplace injuries are sometimes prescribed pain medicines over an extended period of time at increasingly higher doses, which may put them at risk for opioid use disorder and unintentional or intentional overdose.[8],[9] For women, the study found, lost time injuries may lead to a 3-fold increased risk of drug-related death.[10] In a recent study, 79% of employers reported concerns about legal prescription opioid use and 83% were concerned about misuse of illicit opioids, but only half reported they were somewhat prepared to deal with it and less than 20% reported they were extremely well prepared. [11]

Overdose deaths occur across the workforce but are more common in some industries. As much as 43% of all drug overdoses deaths at work occurred specifically in the Transportation and Warehousing, Construction, and Healthcare and Social Assistance sectors. [12] The incidence of drug overdose deaths at work also varies by state. For example, the Massachusetts Department of Public Health reported 54 unintentional drug overdose deaths at work between 2016 and 2017, making unintentional overdoses the leading cause of injury death at work in the state.[13]

Naloxone is a critical tool for preventing opioid overdose deaths

Without immediate intervention, an opioid overdose can quickly lead to death. Naloxone is a medication that can reverse an opioid overdose. Police officers, emergency medical services providers, and community service workers carry the drug for that purpose. The Surgeon General of the United States is urging others who may have the potential to encounter people at risk for opioid overdose to have naloxone available and to learn how to use it to save lives.[14] Research has found that overdose deaths decrease in communities that provide naloxone with opportunities for overdose education.[15]

Any workplace can be at risk of overdose deaths if workers, customers, or visitors use opioids. In 2017, 95% of the 70,237 U.S. drug overdose deaths occurred among the working age population, persons aged 15-64 years.[16] In 2021, the National Institute for Occupational Safety and Health (NIOSH) published a video, “Addressing Opioid Overdoses in the Workplaces,” to help employers and workers understand the risk of opioid overdose and help them establish a workplace naloxone availability and use program. This video was based on a NIOSH factsheet, Using Naloxone to Reverse Opioid Overdose in the Workplace: Information for Employers and Workers.

Naloxone is an effective drug for reversing opioid overdoses.  A variety of naloxone products, including a nasal spray, injection, and auto-injection, are available to respond to an overdose. Consider establishing a naloxone program in your workplace.

For more information

• Prescription Opioid and Benzodiazepine Medications and Occupational Safety and Health
• Opioids in the Construction Industry- Part 1: The Evolution of a Crisis
• Opioids in Construction- Part 2 Impacting Lives
• Opioids in Construction- Part 3 Pathways to Recovery
• NIOSH: Opioids in the Workplace
• Medication-Assisted Treatment for Opioid Use Disorder
• Drug Overdose in the Workplace and the Role of Opioids
• The COVID-19 Pandemic and the Opioid Overdose Epidemic: A Perfect Storm for Workers?
• The Role of Veterinarians in the Opioid Crisis
• Injured Workers More Likely to Die from Suicide or Opioid Overdose
• Law Enforcement Officers’ Health Effects from Exposure to Opioids: Two Case Investigations
•  Workers Using Prescription Opioids and/or Benzodiazepines Can Face Safety and Health Risks
• Fentanyl and the Safety of First Responders: Science and Recommendations
• Fentanyl Exposure Risks for Law Enforcement and Emergency Response Workers
• The Opioid Overdose Epidemic and the Workplace
• A NIOSH Role in Prescription Drug Abuse Prevention

L. Casey Chosewood, MD MPH, is Director of the NIOSH Office for Total Worker Health.

J’ette Novakovich, PhD, MS, MA, is the Assistant Coordinator for the Construction Sector Program and Writer-Editor in the Division of Science Integration.

Jamie Osborne, MPH, CHES® is a Public Health Analyst with the NIOSH Office of the Director.

References

[1] CDC’s Vital Statistics. Products – Vital Statistics Rapid Release – Provisional Drug Overdose Data (cdc.gov). June 9, 2021. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

[2] Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2021. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

[3] Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic. HAN health advisory. Distributed via the CDC Health Alert Network; December 17, 2020, 8:00 AM ET. CDCHAN-00438, https://emergency.cdc.gov/han/2020/han00438.asp

[4] National Safety Council. (2019) National Employer Survey 2019 Opioid Usage In The Workplace. A Research Report for the National Safety Council. B2B International PowerPoint Template October 2018 (nsc.org)

[5] BLS (2021). Deaths from Unintentional Overdoses in the Workplace Continued to Rise in 2019. Washington, DC: Bureau of Labor Statistics, Department of Labor. https://www.bls.gov/opub/ted/2021/deaths-from-unintentional-overdoses-in-the-workplace-continued-to-rise-in-2019.htm

[6] National Safety Council. (2019) National Employer Survey 2019 Opioid Usage In The Workplace. A Research Report for the National Safety Council. B2B International PowerPoint Template October 2018 (nsc.org)

[7] Applebaum K, Asfaw A, O’Leary P, Busey A, Tripodus Y, and Boden L. [2019]. Suicide and drug-related mortality following occupational injury. American Journal of Industrial Medicine, 62, 733-741. https://onlinelibrary.wiley.com/doi/full/10.1002/ajim.23021

[8] Applebaum K, Asfaw A, O’Leary P, Busey A, Tripodus Y, and Boden L. [2019]. Suicide and drug-related mortality following occupational injury. American Journal of Industrial Medicine, 62, 733-741. https://onlinelibrary.wiley.com/doi/full/10.1002/ajim.23021

[9] Dale, AM, Buckner-Petty, S, Evanoff, BA, Gage, BF. (2021) Predictors of long-term opioid use and opioid use disorder among construction worker: Analysis of claims data. Am J Ind Med. 64:48–57. https://doi.org/10.1002/ajim.23202

[10] Applebaum K, Asfaw A, O’Leary P, Busey A, Tripodus Y, and Boden L. [2019]. Suicide and drug-related mortality following occupational injury. American Journal of Industrial Medicine, 62, 733-741. https://onlinelibrary.wiley.com/doi/full/10.1002/ajim.23021

[11] National Safety Council. (2019) National Employer Survey 2019 Opioid Usage In The Workplace. A Research Report for the National Safety Council. B2B International PowerPoint Template October 2018 (nsc.org).

[12] NIOSH. [2020]. Opioids in the Workplace: Understanding the Opioid Crisis. Washington, DC:  National Institute for Occupational Safety and Health, Centers for Disease Control. https://www.cdc.gov/niosh/topics/opioids/data.html

[13] NIOSH. [2020]. Opioids in the Workplace: Understanding the Opioid Crisis. Washington, DC:  National Institute for Occupational Safety and Health, Centers for Disease Control. https://www.cdc.gov/niosh/topics/opioids/data.html

[14] USSG (U.S. Surgeon General) [2018]. Surgeon General’s Advisory on Naloxone and Opioid Overdose.  Washington, DC:  U.S. Department of Health and Human Services, Office of the U.S. Surgeon General. https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory.html

[15] Walley AY, Xuan Z, Hackman HH, et al. [2013]. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ 2013;346:f174. https://www.bmj.com/content/346/bmj.f174

[16] NIOSH. [2020]. Opioids in the Workplace: Understanding the Opioid Crisis. Washington, DC:  National Institute for Occupational Safety and Health, Centers for Disease Control. https://www.cdc.gov/niosh/topics/opioids/data.html