Opioids in the Workplace: NIOSH Extramural Research
NIOSH-funded grantees and other partners are working to address the opioid crisis. These extramural researchers have conducted research and developed resources, including education, training, and surveillance data, related to the prevention of opioid misuse and overdose in working populations. Below, you will find resources intended to help workers, employers, and medical providers who care for workers as they face the opioid epidemic within their communities.
You can also find information on other NIOSH resources via the institute’s opioid topic page.
Education and Training
The Maryland Department of Health—a NIOSH-funded state surveillance program—published a report on a November 2018 conference that focused on strategies to address opioids in the workplace. Workshops during the conference addressed medical, legal, ethical, fiscal, and regulatory challenges facing Maryland employers, workers, and others involved in the opioid workplace response. Presentations focused on potential collaborations and interventions to help Maryland businesses. Presenters shared information on efforts to address societal attitudes on substance use disorders, education and training, insurance coverage, treatment, drug testing policy, employee assistance programs, and the role of primary care providers. The conference was sponsored by multiple organizations, including the Maryland Department of Health and the NIOSH-funded Johns Hopkins Education and Research Centerexternal icon.
The NIOSH-funded North Carolina Occupational Health Surveillance Program recommends actionable strategies for occupational health nurses on the front lines of the opioid crisis in a journal article published in Workplace Health & Safety. Substance use disorders involving prescription drugs impact all aspects of society, including workplace settings. High rates of prescribed opioids can lead to abuse for some injured workers. Research shows that a multilayered approach best addresses this problem, including reducing workplace injuries and illnesses that may lead to opioid prescribing. This effort examines the unique role that occupational health nurses have in addressing opioid use in workplace settings.
NIOSH partnered with The Center for Health, Work & Environment—a NIOSH Total Worker Health® Center of Excellence—to hold a two-day workshop in Denver, Colorado, focused on the well-being of American Indian and Alaska Native workers. This event addressed occupational safety and health issues and related solutions for this worker population, including opioid misuse and overdose as well as injury prevention for construction and utility workers. Workshop attendees identified safety and health priorities for American Indian and Alaska Native workers. Those priorities were then used to develop a worker safety and health strategic plan. Fifty-two participants representing six Tribal Nations, the Indian Health Service, state and local government, and academia attended the workshop.
In collaboration with partners, the NIOSH-funded Center for Health, Work & Environmentexternal icon and Mountain and Plains Education and Research Centerexternal icon at the Colorado School of Public Health developed an evidence-based course to share the best practices for treating patients experiencing pain while monitoring and managing risks for opioid misuse and overdose. Intended for a healthcare audience, the course features guidelines for assessing patients, developing a comprehensive treatment plan, using first-line therapies, initiating an opioid trial and regimen, and preventing diversion of opioid medications. The course also specifically addresses pain management in worker populations.
This two-hour webinar provides Continuing Medical Education credits for medical providers and prescribers.
In 2011, about 3-million workplace injuries were reported in private industries, with more than half requiring some time off. However, because occupational medicine is one of the smallest medical specialties, primary care physicians often evaluate these injured workers. Opioids and other medications that can cause side effects or impairment should be used cautiously in injured workers because they can prolong recovery, prohibit return to work in some cases, or cause additional injury. Through a NIOSH-funded Training Project Grant, researchers at the University of Pennsylvania developed this publication to help guide primary care physicians through the evaluation and treatment of workers with acute or short-term injuries. Furthermore, the guidance underlines the importance of occupational history in the treatment of acute injuries and how to safely facilitate return to work.
The article appeared in American Family Physician Journal.
The construction industry has one of the highest injury rates compared with other industries. Opioids have commonly been prescribed to construction workers to treat pain caused by these occupational injuries. Workers in the industry also have higher rates of opioid overdose death compared with other groups. Because opioid use can lead to addiction and overdose deaths, construction workers should understand the risks of opioid use and the importance of considering alternatives for pain management.
The Center for Construction Research and Training (CPWR) has developed many resources in English and Spanish about opioid deaths, prevention, and pain management alternatives. These resources include fact sheets, toolbox talks, clinical tools, and a new opioids awareness training programexternal icon.
The cost to Connecticut employers from substance use and misuse reaches millions of dollars each year. These costs stem from employees’ lost productivity, days away from work, and increased healthcare costs, among others. To address this issue, the NIOSH-funded Connecticut Department of Public Health surveillance program published The Opioid Crisis and Connecticut’s Workforcepdf iconexternal icon.
This multidisciplinary white paper challenges conventional “punitive” zero-tolerance policies as ineffective, and perhaps even counter-productive in addressing substance abuse issues in the workforce. The publication recommends five key components for employers to incorporate into more effective and compassionate workplace policies such as early identification of substance abuse issues and employer flexibility. The report also discusses the importance of recognizing substance abuse as a chronic disease instead of a personal failing; including more current, evidence-based best practices of substance abuse treatment and recovery professionals; and identifying the important role employers play as a partner in the treatment and recovery of workers and in the support of their families.
This publication developed from a two-year partnership between practitioners and researchers in the fields of public health, substance abuse treatment and recovery, employer human resources, legal services, and insurance providers.
Research and Surveillance Data
The Massachusetts Department of Public Health (MDPH)external icon reported unintentional drug overdose as the leading single cause of fatal injury at work. These unintentional overdoses resulted in 54 deaths in Massachusetts from 2016 through 2017. Although these deaths occurred across most industry sectors, the leading sectors were Accommodation and Food Service and Construction and Real Estate and Leasing. In a Fatality Assessment and Control Evaluation (FACE) report, MDPH provides an overview of these fatal occupational injuries in Massachusetts, including details from both the FACE and the Census of Fatal Occupational Injuries projects. The report also examines other workplace deaths like falls, electrocutions, and exposure to toxic chemicals, as well as workplace opioid and other drug overdoses, homicides, suicides, and motor vehicle-related fatalities occurring during travel on the job.
According to a report by the NIOSH-funded Massachusetts Department of Public Health state surveillance programexternal icon, Massachusetts workers died of opioid overdoses at much different rates depending upon their job. The highest rates were seen in construction and extraction, including quarrying, mining, and oil and gas removal. This was followed by agriculture, forestry, and fishing industries. To understand which industries and occupations have the highest rate of opioid-related deaths, researchers looked at 4,302 publicly available death certificates filed in Massachusetts from 2011 through 2015. Researchers used data from four national surveys to further explore occupational factors that may have contributed to differences in rates of opioid-related deaths in different occupations and industries.
Interventions for the current opioid overdose epidemic generally focus on the use of opioids among human patients. But now, prescribing by veterinarians is also being examined. Most veterinarians can legally prescribe, distribute, carry, and store controlled substances, including opioids. While these drugs are prescribed to treat animals, they have the potential to be diverted to human use and misuse.
To understand this issue, the NIOSH-funded Center for Health, Work & Environmentexternal icon partnered with a local Colorado veterinary society to administer an online survey to 189 of its veterinarian members. The survey focused on animal owners’ misuse of opioids. In particular, it asked about veterinarians’ roles in preventing diversion, their use of Colorado’s prescription drug monitoring program, their awareness of misuse in their clinics, and what resources they may need. Researchers found that 13% of surveyed veterinarians knew an animal owner had injured or intentionally made an animal sick or made them seem hurt or ill to get opioid medications. Additionally, 44% were aware of opioid misuse or an opioid use disorder by either a client or a veterinary staff member. These findings are highlighted in the American Journal of Public Health.
The Maryland Department of Health developed the Prescription Drug Monitoring Program (PDMP)external icon to support healthcare providers and their patients to use prescription drugs safely and effectively. The program collects data on medications prescribed to patients that are controlled substances or drugs regulated by the government because of their potential for addiction. Those who provide prescribed drugs, like pharmacists and healthcare practitioners, report data to the PDMP database. These providers are also required to consult with the program before prescribing controlled substances.
The NIOSH-funded state surveillance program at the Maryland Department of Health recently evaluated the impact of an online training focused on provider use of the PDMP. This evaluation looked at prescribing providers’ attitudes and behaviors towards the program. Overall, most participants saw value in the PDMP, however, their behaviors did not necessarily reflect that belief. The evaluation also revealed that the training affected provider treatment plans through information providers received from the PDMP.
To increase understanding of the opioid crisis in American workers, the NIOSH-funded Training Project Grant at Yale University focused on research related to opioid prescriptions. Yale researchers looked at opioid prescribing patterns for U.S. industrial workers over a decade and identified factors related to chronic or long-term prescribing trends. According to their findings, the number of industrial workers prescribed opioids increased substantially from 2003 through 2013. Predictors of chronic prescribing included older age, hourly wage (versus salaried workers), and diagnoses of low back pain and osteoarthritis.
The study appeared in the Journal of Occupational and Environmental Medicine.
State and national organizations are taking a more comprehensive approach on the treatment of injured workers with long-term, noncancer pain by creating opioid treatment guidelines. However, there is limited information on how these guidelines affect the prescribing behaviors of medical providers and subsequent patient health outcomes. The NIOSH-funded Mountain and Plains Education and Research Centerexternal icon at the Colorado School of Public Health conducted a study to address this issue. Researchers examined the ways that an opioid management program and incentives impacted medical providers’ compliance with state treatment and prescribing guidelines.
The study analyzed data from the Colorado workers’ compensation database, focusing on the amount and types of opioids that providers prescribed to injured workers with chronic pain. According to the study, published in the American Journal of Industrial Medicineexternal icon, providing physicians incentives to adhere to chronic pain management guidelines only temporarily improved prescribing practices.