NIOSH Steps Up the Fight Against Opioid Misuse

According to the National Institute for Occupational Safety and Health (NIOSH), 95% of drug overdose deaths that occurred in 2016 were among the working age population, persons aged 15–64 years.

“While we do not know how many of these individuals were employed at the time of their overdose, we do know that the work environment, including potential work-related injuries, can increase the potential for opioid use,” states NIOSH. The Institute recently released a new webpage to outline its approach to the life cycle of opioid use—from precursors in the workplace to use conditions to containment and decontamination to recommendations targeted for protecting workers.

NIOSH’s framework details an approach to examining workplace conditions that can be risk factors for medically prescribed opioid use becoming opioid misuse, protecting responders from exposure to fentanyls and their equivalents, developing methods of rapid detection of dangerously potent opioids in a workplace, and providing information about effective decontamination of workplaces. The framework comprises the following three parts.

Data

NIOSH says it is obtaining the data needed to characterize the opioid crisis in workers. Data already in NIOSH’s possession include the following:

• 4.5%—According to the National Survey of Drug Use and Health, an estimated 4.5% of respondents aged 18 years or older reported illicit opioid use in the past year. An estimated 66.2% of these self-reported illicit opioid users were employed full- or part-time.
• 38%—The Bureau of Labor Statistics (BLS) reported that overdose deaths at work from nonmedical use of drugs or alcohol increased by at least 38% annually between 2013 and 2016. The 217 workplace overdose deaths reported in 2016 accounted for 4.2% 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.
• 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.

Workers’ compensation has also provided significant information on aspects of the crisis. For example, the number of workers’ compensation claims with prescriptions that include opioids is still high but has been reduced in most states. At the same time, a significant share of workers’ compensation opioid prescriptions is associated with injuries that occurred several years before the prescriptions being written.

Investigations

NIOSH is conducting field investigations to determine the extent of opioid exposures and best approaches for prevention. NIOSH has issued three interim reports:

• Evaluation of Potential Occupational Exposures to Opioids in a City Fire and Police Department, May 2018
• Evaluation of Potential Occupational Exposures to Opioid Drugs During a Law Enforcement and Emergency Medical Services Response, April 2018
• Evaluation of Potential Occupational Exposures to Opioid Drugs During an Emergency Medical Services Response, April 2018

Research

NIOSH’s goal is to transfer knowledge into practice to promote effective interventions and is focusing its investigations in two areas.

• Risk factors of opioid overutilization among workers:
  • Work-related exposures as risk factors for opioid use;
  • Chronic medical conditions as risk factors for opioid use; and
  • Overutilization of opioids when physicians prescribe under employee health services, employer health plans, and workers’ compensation medical care.
• Opioid use conditions that affect workers:
  • Opioid use as a contributor to workplace injuries and decreased productivity;
  • Workforce education about risks of opioid use disorder (OUD);
  • Fitness-for-duty and impairment evaluation;
  • Workplace drug testing;
  • Availability of medical-assisted treatment for OUD;
  • Integration of opioid-affected workers back into the workplace;
  • Reasonable accommodation policy; and
  • Return-to-work policy.

NIOSH’s updated website is at https://www.cdc.gov/niosh/topics/opioids/default.html.