Opioids in the Workplace

Data

The US is in the midst of a drug overdose epidemic. In 2019, there were 70,630 drug overdose deaths in the United States, a nearly 5% increase from 2018. More than 49,800 overdose deaths involved opioids in 2019, with more than 36,300 involving synthetic opioids other than methadone (largely illicitly manufactured fentanyl).¹

Preliminary data suggest that drug overdose deaths have increased during the COVID-19 pandemic.²

Understanding the Opioid Crisis

3.8% – According to the National Survey of Drug Use and Health, an estimated 3.8% of respondents age 18 years or older reported misuse of prescription pain relievers or heroin in the past year. An estimated 63.0% of these persons who self-reported misuse of prescription pain relievers were employed full- or part-time.³

75% — Based on a survey conducted by the National Safety Council, 75% of employers report that opioid use has impacted their workplace, but only 17% report being extremely well-prepared to address the issue.⁴

5.8% – The Bureau of Labor Statistics (BLS) reported that overdose deaths at work from non-medical use of drugs or alcohol increased for the seventh year in a row in 2019. The 313 workplace overdose deaths reported in 2019 accounted for 5.8% of occupational injury deaths that year. It is unknown how many of these deaths involved opioids specifically.⁵

While overdose deaths at work occur in a variety of industries, they are more common in some industries. In a NIOSH analysis of BLS data for the years 2011 to 2016, 43% of drug overdose deaths at work occurred in only three industries – Transportation & Warehousing, Construction, and Healthcare & Social Assistance.⁶
The incidence of drug overdose deaths at work varies by state. 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.⁷

14.8 days – Workers with a current substance use disorder miss an average of 14.8 days per year, while the subset with a pain medication use disorder miss an average of 29 days per year. This is in contrast to an average of 10.5 days for most employees, and an average 9.5 days for workers in recovery from a substance use disorder. ⁸

Workers’ Compensation Data

Data from workers’ compensation systems have played a vital role in the initial identification and response to the opioid overdose epidemic. Workers’ compensation systems provide unique data that follows an individual over time.

In 2020, 34% of all workers’ compensation claims with prescriptions had at least one prescription for opioids based on data from 40 states. This figure has declined from 55% since 2012.⁹

The average amount of opioids (morphine milligram equivalents, MME*) dispensed per worker in the first two years of a workers’ compensation claim with a prescription for opioids varied substantially among the 27 states studied. Over five times as much opioid medication was prescribed in the highest states Delaware and Louisiana, compared to the lowest state, Missouri. Opioid amount per opioid claim decreased in the majority of 27 study states over a three-year period from 2012 to 2016.¹⁰

*Morphine milligram equivalents (MME) – The amount of milligrams of morphine an opioid dose is equal to when prescribed. This value is used as a scale to compare different opioid drugs, accounting for differences in opioid drug type and strength.

As of 2016, 15% of workers’ compensation claims with at least one prescription for opioids had an original date of injury that was 6 or more years prior (year 2010 or earlier) to the current prescription, 30% of opioid claims had a date of injury that was 2-5 years prior, and 55% of opioid claims had a date of injury that was less than 2 years prior, based on data from 40 states.¹¹

Based on data from 28 states for low back injuries occurring between 2008 and 2013 with over 7 days away from work, longer-term workers’ compensation opioid prescriptions (at least 3 prescriptions 6–12 months after injury following at least one prescription in the first 3 months) resulted in a temporary disability that was more than three times longer than for similar workers with similar injuries who did not receive any opioid prescriptions.¹²

Workers’ compensation opioid dosing guidelines may significantly decrease prescription opioid use among injured workers. For example, the mean monthly prevalence of opioid use among all workers with open claims* declined by 25.6% between 2004 (14.4%) and 2010 (10.7%) after guidelines were instituted in a large study that included 161,283 workers receiving opioid prescriptions in Washington State.^13,14

* In WA State, claims typically remain open until a provider certifies that a worker’s injury has healed or would not likely benefit from further medical care.

A recent NIOSH-funded study by the Workers’ Compensation Research Institute (WCRI) found significantly different opioid dispensing rates within the workers’ compensation system based on several factors:¹⁷

Industry in which the injured worker is employed
- Mining (including oil and gas) and Construction had the highest opioid dispensing rates, followed by Agriculture, Forestry, and Fishing and Public Safety
Company size (based on payroll)
- Smaller companies had higher opioid dispensing rates than larger companies
Injured worker age
- Older workers had higher opioid dispensing rates than younger workers
County-level factors (in which the injured workers reside)
- 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
Injury type
- Fractures and carpal tunnel syndrome had the highest opioid dispensing rates, followed by neurologic spine pain

Case Study

In 2005, Franklin et al. published a peer-reviewed paper that not only identified an unusual increase in unintentional opioid-involved overdose deaths but also determined that these deaths occurred to workers who were prescribed opioids for non-catastrophic injuries such as carpal tunnel syndrome or low back pain and over half were prescribed a schedule II opioid.^18,19 The findings by Franklin et al. led, in part, to the development-by a consortium of Washington state agencies that purchase or regulate health care and the 2007 implementation of the first US opioid prescribing guidelines.^{18, 20}

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.mm7006a4external icon

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 – Substance Abuse and Mental Health Services Administration: Center for Behavioral Health Statistics and Quality. (2020). Results from the 2019 National Survey on Drug Use and Health: Detailed tables, Table 1.61 A,B. 2018—2019. https://www.samhsa.gov/data/sites/default/files/reports/rpt29394/NSDUHDetailedTabs2019/NSDUHDetTabsSect1pe2019.htmexternal icon

4 – 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-impactedexternal icon

5 – Bureau of Labor Statistics. (2020). Economic News Release: Census of Fatal Occupational Injuries Summary, 2019. Washington, DC: Bureau of Labor Statistics, Update, December 16, 2020. https://www.bls.gov/news.release/cfoi.nr0.htmexternal icon

6 – 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-2018-043104external icon

7 – 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-publicationsexternal icon

8 – 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.0000000000001157external icon

9 – 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.pdfpdf iconexternal icon

10 – 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-editionexternal icon

11 – 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.pdfpdf iconexternal icon

12 – Neumark, D., Savych, B., Lea R. (2018). The Impact of Opioid Prescriptions on Duration of Temporary Disability. National Council on Compensation Insurance. 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-disabilityexternal icon.

13 – 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.2013.08.001external icon

14 – 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.21998external icon

15 – 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.pdfpdf iconexternal icon

16 – 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-2020external icon

17 – 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.pdfpdf iconexternal icon

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

19 – 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.20191external icon

20 – 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.2014.302367external icon

Page last reviewed: January 30, 2019

Content source: National Institute for Occupational Safety and Health

Opioids in the Workplace

Data

Understanding the Opioid Crisis

Workers’ Compensation Data

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