Data on Opioids in the Workplace

Drug overdose deaths have increased between 2020 and 2021 in the United States.
- The age-adjusted rate of drug overdose deaths rose more than 14%.
- Drug overdose death rates increased for all age groups 25 and over. Adults aged 65 and over had the largest percentage increase.
- The rate of drug overdose deaths increased for deaths involving cocaine and those involving psychostimulants with abuse potential.
In 2021, 106,699 drug overdose deaths occurred, resulting in an age-adjusted rate of 32.4 per 100,000 standard population in the United States. That is more than any other year on record.
Overdose deaths involving synthetic opioids other than methadone (largely illicitly manufactured fentanyl) accounted for nearly 22% of those deaths, almost doubling since 2019.
In 2021, an estimated 3% of survey respondents 18 years or older reported misusing opioids. An estimated 51% of these respondents had full- or part-time jobs.
A survey from the National Safety Council found that 75% of employers report that opioid use has impacted their workplace. However, only 17% report being extremely well-prepared to address the issue.⁵

Workers’ Compensation Data

In 2005, Franklin et al. published a study that identified an unusual increase in unintentional opioid-involved overdose deaths. It also determined that these deaths occurred among workers who received opioid prescriptions for non-catastrophic injuries, such as carpal tunnel syndrome or low back pain. Over half of these workers received prescriptions for a schedule II opioid.^{10, 11} These findings contributed to the development of the first US opioid prescribing guidelines.^{10, 11, 12} Since that time, states have made substantial progress in limiting opioids in workers’ compensation systems, but efforts continue. Below is a summary of key study findings.

In 2022, 32% of workers’ compensation claims with prescriptions had at least one prescription for opioids. This figure has declined since 2012, when 55% of claims with prescriptions included opioids. This is based on data from the National Council on Compensation Insurance for 39 states and DC.^{13, 14}

The opioid amount prescribed per opioid claim decreased in most states from 2012 to 2016.¹⁵ This is based on data from the Workers Compensation Research Institute from 27 states. More recently, the opioid amount prescribed per opioid claim has continued to decrease from 2018 to 2022. This is based on data from the National Council on Compensation Insurance for 39 states and DC.¹⁴

In 2016, 15% of workers’ compensation claims with at least one prescription for opioids were for injuries that occurred 6 or more years prior. 30% of opioid claims had a date of injury that was 2-5 years prior. 55% of opioid claims had an injury date less than 2 years prior. This is based on data from the National Council on Compensation Insurance data for 39 states and DC.¹⁶

A study examined low back injuries causing over 7 days away from work. Results showed that longer-term opioid prescriptions in claims were associated with temporary disabilities that were more than three times longer compared to claims that did not involve any opioid prescriptions.¹⁷ This is based on data from the Workers Compensation Research Institute from 27 states.

In Washington State, the average monthly prevalence of opioid use among all workers with open claims* declined by 25.6% between 2004 and 2010 after instituting dosing guidelines.^{18, 19}

*In Washington State, claims typically stay open until a provider certifies that a worker’s injury has healed. Otherwise, they certify that the injury would not likely benefit from further medical care.

Limiting opioid availability.
Educating health care providers on responsible opioid prescribing.
Increasing awareness among injured workers.

This is based on several research studies.^{20, 21, 22, 23, 24}

NIOSH sponsored a study²⁶ by the Workers Compensation Research Institute that examined opioid dispensing data from 27 states for 2014-2015 and found that dispensing varied by the following factors:

Industry. Mining (including oil and gas) and Construction had the highest opioid dispensing rates, followed by Agriculture, Forestry, and Fishing and Public Safety.
Company size. Smaller companies had higher opioid dispensing rates than larger companies.
Age of the injured worker. Older workers had higher opioid dispensing rates than younger workers.
Type of injury. Fractures and carpal tunnel syndrome had the highest opioid dispensing rates, followed by neurologic spine pain.
County-level factors.
- Rural areas had higher opioid dispensing rates than urban areas
- Areas with low rates of health insurance had higher rates for opioid dispensing than areas with high rates of health insurance.

1 – 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. MMWR Morb Mortal Wkly Rep 2021; 70:202–207. http://dx.doi.org/10.15585/mmwr.mm7006a4

2 – Ahmad, F.B., Rossen, L.M., Sutton, P. (2021). Provisional Drug Overdose Death Counts. National Center for Health Statistics. Designed by L.M. Rossen, A. Lipphardt, F.B. Ahmad, J.M. Keralis, and Y. Chong: National Center for Health Statistics. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

3 – Kariisa M, Davis NL, Kumar S, et al. Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics — 25 States and the District of Columbia, 2019–2020. MMWR Morb Mortal Wkly Rep. ePub: 19 July 2022. DOI: http://dx.doi.org/10.15585/mmwr.mm7129e2.

4 – Substance Abuse and Mental Health Services Administration: Center for Behavioral Health Statistics and Quality. (2020). Results from the 2020 National Survey on Drug Use and Health: Detailed tables, Table 1.61 A,B. 2019—2020. https://www.samhsa.gov/data/sites/default/files/reports/rpt35323/NSDUHDetailedTabs2020/NSDUHDetailedTabs2020/NSDUHDetTabsSect1pe2020.htm#tab1-61a

5 – National Safety Council. (2019). National Employer Survey 2019. Poll: 75% of Employers Say Their Workplace Impacted by Opioid Use. https://www.nsc.org/newsroom/poll-75-of-employers-say-their-workplace-impacted

6 – Bureau of Labor Statistics. (2021). Economic News Release: Census of Fatal Occupational Injuries Summary, 2020. Washington, DC: Bureau of Labor Statistics, Update, December 16, 2021. https://www.bls.gov/news.release/cfoi.nr0.htm

7 – Tiesman, H.M., Konda, S., Cimineri, L., et al. (2019). Drug overdose deaths at work, 2011–2016 Injury Prevention 2019; 25:577-580. http://dx.doi.org/10.1136/injuryprev-2018-043104

8 – Massachusetts Department of Public Health: Occupational Health Surveillance Program. (2019). Fatal Injuries at Work: Massachusetts Fatality Update, 2016-2017. https://www.mass.gov/lists/fatal-work-related-injury-reports-and-publications

9 – Goplerud E., Hodge S., & Benham T. (2017). A Substance Use Cost Calculator for US Employers With an Emphasis on Prescription Pain Medication Misuse. Journal of Occupational and Environmental Medicine, 59(11), 1063–1071. https://doi.org/10.1097/JOM.0000000000001157

10 – Quinones, S. (2015). Dreamland: The True Tale of America’s Opiate Epidemic. Bloomsbury Press. Pgs 202-205, 232-235, 310.

11– Franklin, G. M., Mai, J., Wickizer, T., Turner, J. A., Fulton-Kehoe, D., & Grant, L. (2005). Opioid dosing trends and mortality in Washington State workers’ compensation, 1996-2002. American journal of industrial medicine, 48(2), 91–99. https://doi.org/10.1002/ajim.20191

12 – Franklin, G., Sabel, J., Jones, C. M., Mai, J., Baumgartner, C., Banta-Green, C. J., Neven, D., & Tauben, D. J. (2015). A comprehensive approach to address the prescription opioid epidemic in Washington State: milestones and lessons learned. American journal of public health, 105(3), 463–469. https://doi.org/10.2105/AJPH.2014.302367

13 – Colón, D., Chadarevian, R. (2020). COVID-19’s Impact on Medical Treatment in Workers Compensation—A First Look at 2020. National Council on Compensation Insurance. https://www.ncci.com/Articles/Documents/Insights_COVID-19sImpact-Medical-TreatmentWC-AFirstLook2020.pdf

14 – National Council on Compensation Insurance. (2022).

15 – Wang, D., Thumula, V., Liu, T-C. (2019). Interstate Variations in Dispensing of Opioids. National Council on Compensation Insurance, 5th Edition. Cambridge, Massachusetts: Workers’ Compensation Research Institute, Update, July 31, 2019, WC-19-26. https://www.wcrinet.org/reports/interstate-variations-in-dispensing-of-opioids-5th-edition

16 – National Council on Compensation Insurance. (2017). Medical Data Report Opioid Utilization Supplement For the state of: New Mexico. Update, September 2017. https://workerscomp.nm.gov/sites/default/files/documents/publications/NM_Opioid_Supplement_2017.pdf

17 – Neumark, D., Savych, B., Lea R. (2018). The Impact of Opioid Prescriptions on Duration of Temporary Disability. Workers’ Compensation Research Institute, Cambridge, Massachusetts. Update, March 6, 2018, WC-18-18. https://www.wcrinet.org/reports/the-impact-of-opioid-prescriptions-on-duration-of-temporary-disability

18 – Garg, R. K., Fulton-Kehoe, D., Turner, J. A., Bauer, A. M., Wickizer, T., Sullivan, M. D., & Franklin, G. M. (2013). Changes in opioid prescribing for Washington workers’ compensation claimants after implementation of an opioid dosing guideline for chronic noncancer pain: 2004 to 2010. The journal of pain, 14(12), 1620–1628. https://doi.org/10.1016/j.jpain.2013.08.001

19 – Franklin, G. M., Mai, J., Turner, J., Sullivan, M., Wickizer, T., & Fulton-Kehoe, D. (2012). Bending the prescription opioid dosing and mortality curves: impact of the Washington State opioid dosing guideline. American journal of industrial medicine, 55(4), 325–331. https://doi.org/10.1002/ajim.21998

20 – Ben-Shalom, Y., McIntyre, M., Pu, J., Shenk, M., Zhu, W., Shaw, W. (2020). Workers’ Compensation and the Opioid Epidemic – State of the Field in Opioid Prescription Management. https://www.dol.gov/sites/dolgov/files/OASP/evaluation/pdf/OWCP_OpioidPrescriptionManagement1_FinalReport_Aug2020.pdf

21 – Rothkin, K., Hopkins, E. (2020). Workers’ Compensation Prescription Drug Regulations: A National Inventory, 2020. Update, June, 2020, WC-20-261. https://www.wcrinet.org/reports/workers-compensation-prescription-drug-regulations-a-national-inventory-2020

22 – Moss R., Colón D. (2021). Drug Formulary Implementations – A Look at Impact on Workers Compensation Prescription Drug Experience. https://www.ncci.com/Articles/Pages/Insights-Drug-Formulary-Implementations.aspx

23 – Neumark, D., Savych, B. (2021). Effects of Opioid-Related Policies on Opioid Utilization, Nature of Medical Care, and Duration of Disability. https://www.wcrinet.org/reports/effects-of-opioid-related-policies-on-opioid-utilization-nature-of-medical-care-and-duration-of-disability

24 – Sears, JM, Haight, JR, Fulton-Kehoe, D, Wickizer, TM, Mai, J, Franklin, GM. Changes in early high-risk opioid prescribing practices after policy interventions in Washington State. Health Serv Res. 2021; 56: 49– 60. https://doi.org/10.1111/1475-6773.13564

25 – Wise C. (2020). Opioid Prescribing Across Industry Groups. https://www.ncci.com/Articles/Pages/Insights-Opioid-Prescribing.aspx

26 – Thumula, V., Liu, T-C. (2018). Correlates of Opioid Dispensing. Workers’ Compensation Research Institute, Cambridge, Massachusetts. Update, December 2018, WC-18-48.https://www.wcrinet.org/images/uploads/files/wcri8394.pdf

Data on Opioids in the Workplace

Workers’ Compensation Data

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