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.
Education and Training
In collaboration with partners, the NIOSH-funded Center for Health, Work & EnvironmentExternal and Mountain and Plains Education and Research CenterExternal at the Colorado School of Public Health developed an evidence-based course to share the best practices for treating patients experiencing pain while monitoring for and managing risks for opioid misuse and overdose. Intended for a healthcare audience, it 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 specifically addresses the management of pain 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, occupational medicine is one of the smallest medical specialties, often requiring primary care physicians to fill the role of evaluating injured workers. Opioids and other medications that can cause side effects or impairment should be used cautiously in injured workers because they may 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, while underlining 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 when compared to other industries. In some settings, opioids have commonly been prescribed to construction workers to treat the pain caused by these occupational injuries. The industry also has elevated rates of opioid overdose death compared to other groups. Since use of opioids has led to addiction and overdose deaths, it is important for workers to understand the risks of and alternatives to use of opioids after injury.
The Center for Construction Research and Training (CPWR) has developed many resources in English and Spanish about opioid deaths, prevention, and pain management alternatives.
Substance abuse costs Connecticut employers and workers millions of dollars annually, including lost productivity, days away from work, and increased healthcare costs. To address this problem, the NIOSH-funded Connecticut Department of Public Health published The Opioid Crisis and Connecticut’s WorkforceCdc-pdfExternal.
This multidisciplinary white paper challenges conventional “punitive discipline” human resource models as ineffective in addressing complex substance abuse issues in the workforce. The publication recommends a set of five key components for employers to incorporate into more effective and compassionate workplace policies. These recommendations include: recognizing substance abuse as a chronic disease as opposed to 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
To increase understanding of the opioid epidemic in American workers, the NIOSH-funded Training Project Grant at Yale University is focusing 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 between 2003 and 2013. Predictors of chronic prescribing included older age, hourly wage (versus salaried workers), and the presence of low back pain and osteoarthritis diagnoses.
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, non‐cancer pain through 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. To address this issue, the NIOSH-funded Mountain and Plains Education and Research CenterExternal at the Colorado School of Public Health conducted a study. Researchers examined the ways that an opioid management program and incentives impacted medical providers’ compliance with Colorado state treatment and prescribing guidelines.
The study analyzed data from the Colorado workers’ compensation database and focused on the amount and types of opioids that providers prescribed to injured workers with chronic pain. According to the study, in the American Journal of Industrial MedicineExternal, providing physicians incentives to adhere to chronic pain management guidelines only temporarily improved prescribing practices.