Opioids in the Workplace
The US is in the midst of an opioid overdose epidemic. Opioids (including prescription opioids, heroin, and fentanyl) killed more than 47,600 people in 2017, more than any year on record. 37% of all opioid overdose deaths involve a prescription opioid. (Source: NCHS)
Understanding the Opioid Crisis
95% – In 2017, 95% of the 70,067 US drug overdose deaths occurred among the working age population, persons aged 15-64 years. It is unknown how many were employed at the time of their death. 1
3.8% – According to the National Survey of Drug Use and Health, an estimated 3.8% of respondents age 18 years or older reported illicit opioid use in the past year. An estimated 63.0% of these self-reported illicit opioid users were employed full- or part-time.2
25% – The Bureau of Labor Statistics (BLS) reported that overdose deaths at work from non-medical use of drugs or alcohol increased by at least 25% annually between 2013 and 2017. The 272 workplace overdose deaths reported in 2017 accounted for 5.3% of occupational injury deaths that year, as compared to 1.8% in 2013. It is unknown how many of these deaths were caused by opioids specifically.3
- 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.16
- 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.17
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. 4
Workers’ Compensation Data
Data from workers’ compensation systems has played a vital role in the initial identification and response to the opioid epidemic. Workers’ compensation systems provide a unique dataset that follows an individual over time.
In 2016, 44% of all workers’ compensation claims with prescriptions had at least one prescription for opioids based on data from 40 states. While still high, this figure has declined from 55% since 2012.5
The average amount of opioids (morphine milligram equivalents, MME*) per workers’ compensation claim with a prescription for opioids varied substantially among the 26 states studied. Three times as much opioid medication was prescribed in the highest states compared to the lowest states. Opioid amount per opioid claim decreased in the majority of 26 study states over a three-year period from 2010/2012 to 2013/2015.6
*Morphine milligram equivalents (MME) – The amount of milligrams of morphine an opioid dose is equal to when prescribed. This is how to calculate the total amount of opioids, 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 a date of injury that was 6 or more years prior (year 2010 or earlier), 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.5
Based on data from 28 states for low back injuries occurring between 2008 and 2013 with over 7 days away from work, long-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 temporary disability that was more than three times longer than for similar workers with similar injuries who did not receive any opioid prescriptions.7
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.8,9
* 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.
Many states have taken steps to address opioid use in their workers’ compensation systems by limiting opioid availability, educating health care providers on responsible opioid prescribing, and increasing awareness among injured workers.10,11
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:12
- 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 resides)
- Rural areas had higher opioid dispensing rates than urban areas
- Areas with low rates of health insurance had higher rates for opioids prescribing 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
In 2005, Franklin et al. published a peer-reviewed paper that not only identified an unusual increase in unintentional opioid-related overdose deaths but they 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.13,14 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.13,15
1 – Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999–2017. NCHS Data Brief, no 329. Hyattsville, MD: National Center for Health Statistics. 2018. https://www.cdc.gov/nchs/products/databriefs/db329.htm
2- Results from the 2018 National Survey on Drug Use and Health: Detailed Tables, Table 1.61 A,B
(https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2018R2/NSDUHDetTabs1-60and1-61pe2018.pdfpdf iconexternal icon)
3- Bureau of Labor Statistics . Economic News Release: Census of Fatal Occupational Injuries Summary, 2017. Washington, DC: Bureau of Labor Statistics, December 18, https://www.bls.gov/news.release/cfoi.nr0.htmexternal icon
4- Goplerud E, Hodge S, Benham T. A Substance Use Cost Calculator for US Employers With an Emphasis on Prescription Pain Medication Misuse. Journal of Occupational and Environmental Medicine. 2017;59(11):1063-1071. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5671784/external icon (Using data from the National Survey on Drug Use and Health (NSDUH 2012-2014)
6 – Thumala V, Wang D, Liu T-C . Interstate variations in use of opioids, 4th edition. external icon Cambridge, MA: Workers’ Compensation Research Institute, June, 2017, WC-17-28.
7 – Savych B, Neumark D, Lea R. .Impact of opioid RX on duration of tempoary disability.external icon Cambridge, MA: Workers’ Compensation Research Institute, March 2018, WC-18-18.
8 – Garg RK, Fulton-Kehoe D, Turner JA, Bauer AM, Wickizer T, Sullivan MD, Franklin GM. Changes in opioid prescribing for Washington workers’ compensation claimants after implementation of an opioid dosing guideline for chronic noncancer pain: 2004 to 2010.external icon J Pain. 2013 Dec;14(12):1620-8.
9 – Franklin GM, Mai J, Turner J, Sullivan M, Wickizer T, Fulton-Kehoe D.Bending the prescription opioid dosing and mortality curves: impact of the Washington State opioid dosing guideline. Am J Ind Med. 2012 Apr;55(4):325-31.
10 – International Association of Industrial Accident Boards and Commissions (IAIABC), Opioid Policy Inventory, August 2018external icon.
11 – Rothkin K, Hopkins E . (Workers’ Compensation Prescription Drug Regulations: A National Inventory, 2018.external icon Cambridge, MA: Workers’ Compensation Research Institute, September, 2018, WC-18-41.
12 – Thumala V, Wang D, Liu T-C . WCRI Correlates of Opioids Dispensingpdf iconexternal icon. Cambridge, MA: Workers’ Compensation Research Institute, December, 2018, WC-18-48.
13 – Quinones S. Dreamland: The True Tale of America’s Opiate Epidemic. Bloomsbury Press; 2015 pg 202-205, 232-235, 310
14 – Franklin GM, Mai J, Wickizer T, Turner JA, Fulton-Kehoe D, Grant L. Opioid dosing trends and mortality in Washington State workers’ compensation, 1996-2002. Am J Ind Med. 2005 Aug;48(2):91-9.
15 – Franklin G, Sabel J, Jones CM, Sabel J, Jones CM, Mai J, Baumgartner C, Banta-Green CJ, Neven D, Tauben DJ. A Comprehensive Approach to Address the Prescription Opioid Epidemic in Washington State: Milestones and Lessons Learned. American Journal of Public Health. 2015;105(3):463-469. doi:10.2105/AJPH.2014.302367.
16 – Tiesman HM, Konda S, Cimineri L, et al. Drug overdose deaths at work, 2011–2016. Injury Prevention Published Online First: 10 April 2019. doi: 10.1136/injuryprev-2018-043104.
17 – Massachusetts Department of Public Health – Occupational Health Surveillance Program. 2019. Fatal Injuries at Work: Massachusetts Fatality Update, 2016-2017. Available at: https://www.mass.gov/lists/fatal-work-related-injury-reports-and-publicationsexternal icon.