NIOSH Miner Health Program Addresses Substance Use and Work
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Drug overdoses have accelerated over the past two decades, and in 2017, the United States Department of Health and Human Services deemed the opioid crisis a public health emergency. In April of 2021, the U.S. surpassed 100,000 drug overdose deaths for the preceding 12-month period, marking a nearly 29% increase from the previous 12-months. This milestone is 80% higher than the number of deaths for the same period five years prior.[1] The overdose epidemic has been fueled by the rapid rise in the use of synthetic opioids, such as illegally made fentanyl, as well as by psychostimulants like cocaine and methamphetamine and poly-substance use. Between 2013 and 2019, the overdose rate attributable to synthetic opioids grew by 1,040%.[2]
Workers in the mining industry exhibit among the highest rates of substance use, misuse, and overdose relative to other industries.[3] [4] While other comparable trade industries such as construction also experience high rates, this blog highlights elevated health risks in mining and a new research program designed to improve mine worker health and well-being.
Mine Workers Bear Greater Burden in the Opioid Crisis
Mine workers experience significantly higher rates of unintentional injuries and cumulative strain relative to workers in most other industries.[5] They are more often prescribed opioid pain medications and for longer durations[6] and exhibit among the highest rates of substance use, misuse, and overdose relative to other industries. [3] [4] Further, workers in extraction (mining, oil, and gas) * as well as construction have demonstrated among the highest rates of opioid-related deaths relative to other industries. [6]
Work Factors Can Increase Health Risks for Mine Workers
The conditions and design of work can increase individuals’ risk for substance use, misuse, and overdose.[7] Workers in mining often experience work-related stressors, including nonstandard shift schedules, work insecurity, physically demanding tasks, and numerous hazardous exposures, such as heat, noise, and environmental contaminants. In turn, these are associated with high rates of respiratory illnesses, hearing loss, fatigue, heat stress and heart disease, as well as high rates of mental distress, depression, and suicide. [8] [9]
Work-related traumatic injuries and cumulative physical strain may lead to workers’ use of prescription opioids and/or self-medication to manage pain, which may subsequently lead to substance misuse and overdose. Work-related environmental hazards and psychosocial factors present another pathway to substance misuse.[10] These stressors have also been associated with depression and suicide.[11]
NIOSH Research Program Promotes the Improved Health and Well-being of Mine Workers
Industry partners and collaborators have called on the National Institute for Occupational Safety and Health (NIOSH) to address these pressing concerns as research priorities. As part of the NIOSH Mining Program, the Miner Health Program (MHP) was recently launched as a long-term, strategic effort to holistically understand and improve the health and well-being of mine workers. The Miner Health Program focuses on organizational structure, policies, and practices that support worker health and well-being through healthier work design, decreasing hazards, preventing injury, and addressing psychosocial risks. Informed by a Total Worker Health® framework, the Miner Health Program’s research recognizes the connections between workplace, worker, family, and societal factors, highlighting the importance of health equity in addressing substance use and overdose within the context of work.
Workplace Responses to Reduce Risk, Support Recovery, and Promote Miner Health
Historically, the workplace has been mostly overlooked as a setting in which to implement interventions to address substance use, misuse, overdose, and mental health concerns.[12] [13] However, as the number of overdoses rise and with many occurring in workplace settings, employers increasingly understand the urgency of engaging in prevention efforts. Over the past several years, several research entities and advocacy organizations have developed a range of resources that are freely available to support worker health comprehensively.
The Total Worker Health (TWH) approach helps employers select and integrate a range of health and prevention strategies to build more effective and holistic organizational responses tailored to the unique needs of their workforce. Research has documented that integrated workplace approaches are more effective.[14] These include strategies that aim to reduce factors predictive of substance use, such as injury and work stressors, as well as strategies that reduce the negative outcomes for workers already using or misusing opioids and other substances.[15] Examples of employer approaches include prescription drug monitoring and pain management programs, employee assistance programs, workplace naloxone programs, and training to increase awareness of the risks of opioid use, reduce stigma, and connect workers with counseling, treatment, and recovery resources as needed.
Employers also can incorporate publicly available training resources into their prevention efforts. The Worker Training Program out of the National Institute of Environmental Health Sciences (NIEHS) provides an in-depth curriculum and training resources to strengthen worker awareness about occupational risk factors for opioid use disorders.[16] In addition, NIEHS recently launched a new resource to help workplaces design their own opioid use prevention and support programs. The document, Initiatives to Prevent Opioid Misuse and Promote Recovery Friendly Workplace Programs, includes summaries of initiatives, training programs, toolkits, and resources developed by employers, labor unions, community-based organizations, and government agencies.
Industry-specific curricula can be tailored to address the unique needs of employers and workers. Several recent initiatives provide training resources in mining and construction. These include the development and evaluation of recent training curricula for stone, sand, and gravel (SSG) workers in Massachusetts[17] and for construction workers by the CPWR – The Center for Construction Research and Training.[18]
Union-based prevention, treatment, and recovery programs are also growing. A recent evaluation of three union-based peer training programs designed to increase awareness and prevent substance use demonstrated promising outcomes, including increased worker knowledge about opioids, reduced perceptions of stigma around seeking help, and increased confidence in referring a co-worker needing help to resources.[19] Research is also emerging that demonstrates the effectiveness of peer treatment and recovery support programs in reducing substance use and improving a range of recovery outcomes.[20] [21] Reaching beyond the immediate reduction of substance use, peer recovery support focuses on long-term recovery and embraces self-actualization, community and civic engagement, and overall wellness.[22]
NIOSH has developed and continues to build upon guidance for implementing Workplace Supported Recovery programs, evidence-based policies, programs, and practices by employers to reduce multiple risk factors, help workers seek the care they need, and provide assistance in recovery. This may include developing return-to-work plans and supporting second chance employment, providing workplace accommodations and other return to work assistance, and providing peer support and peer coaching to bolster the social supports available to workers in recovery. A recovery-supportive workplace creates work environments that proactively prevent substance use, reduce stigma, and encourage treatment and sustained recovery. An ideal Workplace Supported Recovery program would also incorporate other tools and resources available for workers seeking treatment and recovery, including the encouragement of and access to treatment for opioid use disorder, and a workplace naloxone availability and use program.
Conclusions, Next Steps, and Feedback
Strengthening work-based prevention efforts related to drug use and offering confidential access to treatment and recovery supports is essential to more fully safeguarding miners during and after their years of work. Comprehensive and integrated interventions structured by a TWH framework can guide employers, labor unions, and community organizations in identifying worker needs and evidence-informed interventions. Research is also needed on the best ways to increase worker awareness of opioid harms, to help workers and managers recognize signs of drug use disorders, and to improve support while reducing stigma. Improved organizational practices, such as the use of prescribing guidelines, more supportive workplace polices (that go beyond zero tolerance), and readily accessible union/labor resources, peer supports, and employee assistance programs (EAPs) are also vital.
Miner Health Program collaborations and partnerships have been essential to NIOSH for identifying research and evaluation priorities related to miner substance use/overdose and for effectively disseminating actionable findings and supportive resources. Given the unique conditions and contexts of mining, collaboration across the industry is essential for effectively designing and adapting workplace resources and to maximize the impact of the Miner Health Program.
What employer or union-based efforts are you aware of that support substance use prevention, treatment, and/or recovery for mine workers? We welcome your feedback in the comments below.
Carol T. Nixon, PhD, is a Health Science Evaluator with the NIOSH Spokane Mining Research Division.
Zoë J. Dugdale, MPH, is a Research Epidemiologist with the NIOSH Spokane Mining Research Division.
Jamie C. Osborne, MPH, CHES® is a Public Health Analyst with the NIOSH Office of the Director.
L. Casey Chosewood, MD MPH, is Director of the NIOSH Office for Total Worker Health.
The NIOSH Spokane Mining Research Division and the TWH Office have collaborated to develop this blog for International Overdose Awareness Day.
*The term extraction refers to mining and oil and gas extraction combined.
Resources
The Miner Health Program, 2020-2030 Strategic Agenda
NIOSH Total Worker Health® Program
Workplace Supported Recovery Program
NIEHS Training: Opioids & Substance Use: Workplace Prevention & Response
Initiatives to Prevent Opioid Misuse and Promote Recovery Friendly Workplace Programs
The Center for Construction Research and Training (CPWR)
References
[1] Centers for Disease Control and Prevention. (2021). Drug overdose deaths in the U.S. top 100,000 annually. Retrieved August 24,2022, from https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm
[2] Mattson, C. L., Tanz, L. J., Quinn, K., Kariisa, M., Patel, P., & Davis, N. L. (2021). Trends and geographic patterns in drug and synthetic opioid overdose deaths—United States, 2013–2019. Morbidity and Mortality Weekly Report, 70(6), 202.
[3] Asare-Doku, W., Rich, J., Kelly, B., & James, C. (2020). Mental health interventions in the mining industry: A narrative review. Mental Health Review Journal, 25(2), 153-167.
[4] Gu, J. K., Allison, P., Trotter, A. G., Charles, L. E., Ma, C. C., Groenewold, M., … & Luckhaupt, S. E. (2022). Prevalence of self-reported prescription opioid use and illicit drug use among us adults: NHANES 2005–2016. Journal of Occupational and Environmental Medicine, 64(1), 39.
[5] Arif, A. A., & Adeyemi, O. (2020). The prevalence of chronic diseases among current and ex-miners in the United States. Journal of Occupational and Environmental Medicine, 62(3), 227-231.
[6] Morano, L. H., Steege, A. L., & Luckhaupt, S. E. (2018). Occupational patterns in unintentional and undetermined drug-involved and opioid-involved overdose deaths—United States, 2007–2012. Morbidity and Mortality Weekly Report, 67(33), 925
[7] Niedhammer, I., Bertrais, S., & Witt, K. (2021). Psychosocial work exposures and health outcomes: A meta-review of 72 literature reviews with meta-analysis. Scandinavian Journal of Work, Environment & Health, 47(7), 489.
[8] Peterson, C., Sussell, A., Li, J., Schumacher, P. K., Yeoman, K., & Stone, D. M. (2020). Suicide rates by industry and occupation—National Violent Death Reporting System, 32 states, 2016. Morbidity and Mortality Weekly Report, 69(3), 57
[9] Stewart, A. G. (2020). Mining is bad for health: a voyage of discovery. Environmental geochemistry and health, 42(4), 1153-1165.
[10] Shaw, W. S., Roelofs, C., & Punnett, L. (2020). Work environment factors and prevention of opioid-related deaths. American Journal of Public Health, 110(8), 1235-1241.
[11] Milner, A., Witt, K., LaMontagne, A. D., & Niedhammer, I. (2018). Psychosocial job stressors and suicidality: A meta-analysis and systematic review. Occupational and Environmental Medicine, 75(4), 245-253.
[12] Le, A. B., & Rosen, J. D. (2021). It is time to implement primary prevention in the workplace to ameliorate the ongoing US Opioid epidemic. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 31(3), 210-218.
[13] Rosen, J., Zelnick, J. R., Zoeckler, J., & Landsbergis, P. (2021). Introduction to the Special Issue: Opioids and the workplace-risk factors and solutions. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 31(3), 201-209.
[14] LaMontagne, A. D., Martin, A., Page, K. M., Reavley, N. J., Noblet, A. J., Milner, A. J., … & Smith, P. M. (2014). Workplace mental health: Developing an integrated intervention approach. BMC Psychiatry, 14(1), 1-11.
[15] Substance Abuse and Mental Health Services (SAMHSA). Peers supporting recovery from substance use disorders. Retrieved August 24, 2022, from Value of Peers Infographics: Peer Recovery (samhsa.gov)
[16] National Institute of Environmental Health Sciences (N.D.). Opioids & substance use: Workplace prevention & response. Retrieved August 22, 2022, from https://tools.niehs.nih.gov/wetp/index.cfm?id=2587
[17] Roelofs, C. (2022). Results of an opioid hazard awareness training intervention for stone, sand, and gravel miners. Mining, Metallurgy & Exploration, 39(1), 55-61.
[18] Roelofs, C., Rodman, C., Rinehart, R., & Cain, C. T. (2021). Preventing opioid-related harms in the construction industry. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 31(3), 367-372.
[19] Roelofs, C., Sugerman-Brozan, J., Kurowski, A., Russell, L., & Punnett, L. (2021). Promoting opioid awareness through a union-based peer training model. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 31(3), 286-297.
[20] Bassuk, E. L., Hanson, J., Greene, R. N., Richard, M., & Laudet, A. (2016). Peer-delivered recovery support services for addictions in the United States: A systematic review. Journal of Substance Abuse Treatment, 63, 1-9.
[21] Reif, S., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., … & Delphin-Rittmon, M. E. (2014). Peer recovery support for individuals with substance use disorders: Assessing the evidence. Psychiatric Services, 65(7), 853-861.
[22] Substance Abuse and Mental Health Services (SAMHSA). Primary, secondary and tertiary prevention strategies & interventions for preventing NMUPD and opioid overdose across the IOM continuum of care. Retrieved August 24, 2022, from https://cadcaworkstation.org/public/DEA360/Shared%20Resources/Root%20Causes%20and%20other%20research/Crosswalk%20PST_USI_models%20with%20NMUPD_PDO__%20examples_9_27_2016_revised.pdf
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