Drug Overdose in the Workplace and the Role of Opioids

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The supplier overdose pandemic continues to afflict our country. Nationally, location were much than 70,000 supplier overdose deaths successful 2017 [i] involving opioids (such arsenic fentanyl, heroin and hydrocodone), stimulants (such arsenic cocaine and methamphetamine), and alcohol.[ii] Nearly 70% of these deaths progressive an opioid.[ii]

Recent information show that supplier overdoses astatine activity are increasing. A National Institute for Occupational Safety and Health (NIOSH) study of Bureau of Labor Statistics nationalist information identified that while supplier overdose deaths were little predominant compared pinch different causes of occupational wounded deaths, location was an yearly summation of 24% successful supplier overdose deaths betwixt 2011 and 2016. Opioids, including heroin and medicine drugs, and illicitly manufactured fentanyl accounted for 44% of nan supplier overdose deaths astatine activity betwixt 2011 and 2016.[iii] Illicit narcotics specified arsenic methamphetamine, phencyclidine (PCP) and cocaine accounted for 24% of these deaths.

This disturbing inclination has been identified successful Massachusetts, wherever nan state’s Department of Public Health precocious released a report showing that unintentional supplier overdoses were nan starring origin of workplace decease successful Massachusetts successful 2016 and 2017. Of nan 54 supplier overdose deaths that occurred successful Massachusetts workplaces, 85% progressive fentanyl, nan highly potent synthetic opioid. The mean property of workplace overdose decease victims was 39.

The precocious proportionality of opioid overdose deaths successful Massachusetts whitethorn beryllium owed to respective factors. First, nan wide grade of nan opioid overdose pandemic successful nan authorities which has seen opioid-overdose deaths triple betwixt 2011 and 2016, though much caller information bespeak that nan tide is turning. [iv] Another facet whitethorn beryllium enhanced information postulation and accrued attraction and resources that Massachusetts has dedicated to identifying opioid-related overdoses. These include: nan Census of Fatal Occupational Injuries collected successful conjunction and pinch support from nan Bureau of Labor Statistics; nan Fatality Assessment and Control Evaluation (FACE) programme pinch backing support from NIOSH; and, nan State Unintentional Drug Overdose Reporting System (SUDORS) pinch backing support from nan Centers for Disease Control and Prevention (CDC). It is apt that nan concerted efforts successful Massachusetts identified opioid overdose cases successful nan workplace that mightiness not person been different identified. As such, it is apt that different states without these resources person opioid overdoses that are unrecognized arsenic occurring successful nan workplace.

In Massachusetts, nan 2016-2017 report, identified nan pursuing industries and occupations pinch precocious numbers of supplier overdose deaths successful nan workplace.

• Accommodation and nutrient work (nine deaths)
• Construction and extraction (six deaths)
• Real property and licensing (six deaths)

A antecedently published report utilizing information from decease certificates from 2011-2015, recovered that nan complaint of each fatal opioid overdose successful Massachusetts (not only those occurring astatine work) varied importantly by manufacture and business of nan decedents, pinch building and extraction workers having some a precocious complaint (151 deaths per 100,000 workers) and a precocious number of opioid-related overdose deaths (1,096 retired of 4,302 full among nan full moving population). In fact, nan opioid-related decease complaint for those employed successful building and extraction business was six times nan mean complaint for each Massachusetts workers (25 deaths per 100,000 workers). In addition, nan complaint of fatal opioid-related overdose was higher among workers employed successful industries and occupations known to person precocious rates of work-related injuries and illnesses. This uncovering is accordant pinch erstwhile investigation documenting communal usage of prescribed opioids for guidance of acute and chronic symptom pursuing work-related injury. The complaint was besides higher among workers successful occupations pinch little readiness of paid sick time off and little occupation information specified arsenic building and extraction, farming, fishing, and forestry, and nutrient mentation and serving related occupations.

NIOSH has recovered similar, but besides unsocial results successful nationalist analyses including accrued rates of supplier overdose decease astatine activity successful transportation, construction, mining, and healthcare. [iii] Additional NIOSH investigation has recovered elevated rates of supplier overdose (not only those occurring astatine work) successful construction, healthcare, and extraction (mining and lipid and state extraction).[v] NIOSH analyses person besides identified differences successful nan type of supplier implicated successful nan overdose by manufacture aliases business which is important for targeted prevention efforts.[iii,v]
 

Next Steps

Both NIOSH and Massachusetts are taking action successful consequence to these information connected supplier overdose successful nan workplace. In Massachusetts, nan state’s Department of Public Health is moving pinch workplace wellness and information stakeholders, constituent addiction work providers, and argumentation makers to supply opioid consciousness adjacent training for precocious consequence worker groups and place different further opportunities to instrumentality worker-oriented opioid overdose prevention strategies. Massachusetts besides developed a unsocial investigation tool, called nan Public Health Data Warehouse (PHD) which links complete 25 statewide databases pinch nan extremity of analyzing trends successful nan opioid epidemic. In addition, Massachusetts is processing information procedures for erstwhile a fatal workplace overdose occurs. These procedures are based connected nan FACE programme inspection protocols. Information obtained from these evaluations will thief guideline improvement of recommendations for employers focusing connected wounded prevention and recovery-friendly workplaces.

NIOSH is utilizing Total Worker Health® principles to reside nan opioid crisis, recognizing that nan effects of supplier usage and misuse are not isolated to activity aliases location environments, and nan imaginable for supplier usage disorders whitethorn beryllium preceded by injuries that hap successful nan workplace, pinch nan consequences affecting some an individual’s moving life arsenic good arsenic their location life.

NIOSH is opening to measure issues related to Workplace Supported Recovery to assistance workers and employers arsenic they thief workers successful curen for opioid usage disorder, and different constituent usage disorders, successful nan return to productive, supportive employment. When completed these efforts will supply employers pinch evidence-based policies and programs to trim nan consequence factors associated pinch constituent misuse and nan progression to a constituent usage upset and return steps to assistance workers who are successful betterment successful staying astatine activity aliases returning to work. NIOSH will statesman nan effort by seeking input from partners done a published Federal Register Notice successful early 2020.

The NIOSH Opioids successful nan Workplace webpage contains accusation and resources including: Things to see successful establishing a workplace naloxone program, and Things employers should cognize astir medicated assisted treatment. To reside gaps successful knowledge successful nan opioid response, NIOSH has precocious incorporated related investigation goals into its Strategic Plan for FY2019-2023.

Conclusions

The latest accusation from NIOSH and from Massachusetts underscores nan request for acquisition and argumentation interventions targeting high-rate worker populations to forestall supplier overdose deaths. Interventions should reside workplace hazards that origin injuries for which opioids are prescribed, arsenic good arsenic due symptom guidance pursuing injury, including safer opioid prescribing, entree to evidence-based curen for opioid usage disorders, entree to alternatives to opioids for nan curen of injuries and pain, and overdose prevention education.

We must not suffer show of nan truth that these information correspond individuals whose lives person been lost, pinch impacts connected families, employers and society. Additional efforts to identify, describe, and show supplier overdose deaths astatine activity are warranted to understand nan existent load and guideline nan consequence to nan epidemic.

In nan remark conception below, please stock immoderate steps your workplace has taken to reside nan impacts of nan supplier pandemic connected workers.

Dawn Castillo, MPH, is nan Director of nan NIOSH Division of Safety Research and Co-Chair of nan NIOSH Opioids Data Framework Working Group.

Michael Fiore, MS, leads nan Occupational Fatality Unit wrong nan Occupational Health Surveillance Program astatine nan Massachusetts Department of Public Health.

Emily Sparer-Fine, ScD, is nan Director of nan Occupational Health Surveillance Program astatine nan Massachusetts Department of Public Health.

Hope M. Tiesman, PhD, is simply a investigation epidemiologist successful nan NIOSH Division of Safety Research and personnel of nan NIOSH Opioids Data Framework Working Group.

Steve Wurzelbacher, PhD, is nan Director of nan NIOSH Center for Workers’ Compensation Studies (CWCS) and Co-Chair of nan NIOSH Opioids Data Framework Working Group.

Other NIOSH Science Blogs addressing nan Drug Overdose Epidemic and Workers

References

[i] Source: National Vital Statistics System, National Center for Health Statistics, 2018. https://www.cdc.gov/nchs/products/databriefs/db329.htm

[ii] Source: National Vital Statistics System, National Center for Health Statistics, 2018. https://www.cdc.gov/nchs/data/databriefs/db329_tables-508.pdf#page=4

[iii]  Tiesman HM; Konda S; Cimineri L; Castillo DN. Drug overdose deaths astatine work, 2011-2016. Inj Prev 2019 Nov; 25(6):577-580.

[iv] MA Department of Public Health, Data Brief: Opioid-Related Overdose Deaths among Massachusetts Residents, posted November 2019. https://www.mass.gov/doc/opioid-related-overdose-deaths-among-ma-residents-november-2019/download

[v]  Harduar Morano L, Steege AL, Luckhaupt SE. Occupational Patterns successful Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths — United States, 2007–2012. MMWR Morb Mortal Wkly Rep 2018;67:925–930. DOI: http://dx.doi.org/10.15585/mmwr.mm6733a3external icon.