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 preventing 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 overdose epidemic within their communities.
You can also find information on other NIOSH resources via the institute’s opioid topic page.
Education and Training
The Recovery Friendly Workplace Toolkit is a new online resource for employers designed to help treat substance use disorders as a disease and not a moral failing. Its focus is on supporting treatment, eliminating stigma, and offering strategies to help workers remain on the job. The online toolkit is specifically intended to help companies that may have limited experience and information about substance use disorders implement a recovery-friendly workplace program. Developed by Connecticut’s Occupational Health Fundamental-Plus Surveillance Program, the toolkit aims to help employers play a role in supporting their employees who are seeking treatment and recovery.
Prior to the toolkit, Connecticut’s surveillance program created Opioid Use in Connecticut’s Workforce—a program to help employers recognize and support employees with an opioid or other substance use disorders. More information on this program is available on the Connecticut Department of Public Health’s website below. The Connecticut Occupational Health Fundamental-Plus Surveillance Program is a NIOSH-supported state surveillance program.
First responders may encounter substances that contain unknown opioids. The Georgia Occupational Safety and Health Surveillance Program (GA-OHS) created a fact sheet titled First Responder Safety Precautions for Dealing with Unknown Opioids that highlights precautions for all first responders. The fact sheet also includes an opioid exposure risk assessment. The document was shared with all licensed emergency medical service (EMS) personnel in the state, reaching over 20,000 workers. GA-OHS also collaborated with the Department of Public Health’s (DPH) Opioid Substance and Misuse Response Unit to share on the DPH’s opioid epidemic webpage for first responders and post on the GA DPH EMS Safety Advisories webpage. The Georgia Association of Chiefs of Police, the largest association of law enforcement administrators in Georgia, also featured it in their newsletter.
The campaign “Hey, Tough Guy…Empowering Heathy Connections at Work” focuses on suicide prevention and opioid overdose education and outreach for construction workers. The Georgia Occupational Safety and Health Surveillance Program (GA-OHS) worked with the Associated General Contractors (AGC) of Georgia, providing state level data on suicides among construction workers and opioid drug overdoses among all GA residents in the toolbox talk. GA-OHS also created pre- and post-evaluations to find the impact of the awareness meetings and suicide prevention trainings.
GA-OHS, AGC members, and OSHA met in September 2020 to discuss resources available to prevent suicide and opioid deaths in construction. The presentation was distributed to all AGC-Georgia’s members, consisting of over 600 companies. AGC-Georgia encourages its members to use the presentation in their toolbox talks with their teams to bring more attention to mental health within the construction industry.
Researchers at the Rocky Mountain Center for Occupational & Environmental used data from over 57,733 truck drivers over 7 years to identify the relationship between the prevalence of opioid use and the subsequent filing of workers’ compensation claims. The study examined data from drivers’ initial commercial driver medical exam (CDME), employment data, and workers’ compensation claims data. The results showed that drivers who reported opioid use at their initial medical exam visit filed subsequent workers’ compensation claims 1.81 times sooner than drivers who did not report opioid use at their CDME when controlling for age, gender, body mass index, and diastolic blood pressure. This information may help inform training programs as they discuss accident risks and prescribers about increased risks of injury among drivers who use opioids.
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 substance use disorders 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 an opioids awareness training program.
Research shows that farmers and farm workers may be at a higher risk for substance use disorders. High-hazard industries like agriculture may lead to injury or painful conditions that commonly have been treated with opioids. In January 2020, the Southeastern Coastal Center for Agricultural Health and Safety held a webinar, Investigating Opioid and Alcohol Risk and Misuse Among Agricultural Workers, which described varied research studies across the United States related to opioid and alcohol use and misuse among agricultural populations. The Southeastern Coastal Center for Agricultural Health and Safety is located at the University of Florida and is one of 11 NIOSH-funded Centers for Agricultural Safety and Health (Ag Centers).
Researchers at the Heartland Center for Occupational Health and Safety identified potential best practices for treating veterans with substance use disorder (SUD) to improve treatment adherence. In a retrospective cohort study of veterans diagnosed with opioid use disorder (OUD) and treated with buprenorphine, researchers found that less patients stopped treatment when using telehealth visits for SUD when compared with in-person clinical visits. This suggests that telehealth visits may be a good option to engage patients in OUD management. Efforts to expand services may improve treatment retention and health outcomes for patients in veteran-serving and other healthcare systems.
Research and Surveillance Data
Timely data are key to effective public health response. A recent study by the Kentucky Occupational Safety and Health Surveillance Program aimed to develop a machine learning method to classify free-text death certificates as drug overdoses to provide faster drug overdose mortality surveillance. The top scoring machine learning model achieved significantly higher performance for sensitivity (p<0.001) than the rule-based approach. This model can be deployed on death certificates as soon as the free-text is available, eliminating the time needed to manually code the death certificates. Machine learning using natural language processing is a relatively new approach in the context of surveillance of health conditions.
The Louisiana Department of Health’s Occupational Health Surveillance Program used information from Louisiana death certificates to describe opioid-related overdose deaths from 2014 through 2019 by industry and occupation. Opioid-related overdose death rates (per 100,000) for 25–44-year-olds (17.1), males (20.3), and white (17.1) workers were significantly higher than the rates for all workers (13.8). The rate of fatal opioid overdose varied significantly by industry and occupation. Workers in certain occupational groups had high rates, including workers in construction and extraction and in installation, repair, and maintenance. Construction and extraction workers accounted for 25% of all opioid-related deaths among the working population. Those workers faced an opioid-related death rate almost four times the average rate for all Louisiana workers.
Opioid use in the treatment of musculoskeletal injuries is a complex decision where providers must balance benefits with risk. Previous research has shown an association between higher opioid doses and adverse health effects. University of Cincinnati Education and Research Center (UC ERC) investigated whether opioid prescriptions are associated with increased deaths and costs through an injury mechanism or as a direct result of the opioid prescription. Researchers analyzed data for 144,553 deidentified Ohio Bureau of Workers’ Compensation claims from 2010 through 2014 with shoulder, knee, and low back injuries and followed them until 2016. Several outcomes, including the likelihood of claimant death, showed significant associations with the maximum claim-prescribed daily morphine equivalent dose. The authors suggest that a focus on provider education, increased use of non-opioid pain medications, and early intervention for minor soft-tissue injuries could reduce future deaths, disability, and claim costs.
A recent study revealed first responders’ recollections, beliefs, and concerns about possible on-the-job exposure to opioids and other drugs. Only a small fraction of first responders believed they had experienced symptoms related to opioid exposure in overdose response calls. However, half were concerned about potential exposures and half were unaware of the available guidance on prevention. Researchers in Kentucky, Virginia, Mississippi, and Georgia analyzed a total of 5,955 surveys after emailing an anonymous convenience sample survey. The high level of concern about potential exposure highlights the need for targeted training interventions. The responses showed that further distribution of existing trainings is needed to ensure first responders understand occupational opioid exposures. Education and training will help minimize stress associated with the potential but rare exposures.
Veterans with opioid use disorder have an increased risk of suicide and overdose compared with the general population. Buprenorphine, a U.S. Food and Drug Administration-approved medication to treat opioid use disorder, has shown benefits, including decreased risk of illicit drug use and overdose. Researchers at the Heartland Center for Occupational Health and Safety assessed death outcomes among veterans up to 5 years after starting treatment with buprenorphine. Results show that veterans who were not receiving buprenorphine were 4.33 times more likely to die by suicide/overdose than those receiving buprenorphine treatment on any given day. This suggests that providers should consider whether buprenorphine may benefit their patients and lower the risk of overdose death.
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 & Environment 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.