A Centers for Disease Control and Prevention (CDC) study that examined unintentional or undetermined overdose deaths in 26 occupation groups found that construction occupations had the highest proportional mortality rates (PMRs) of deaths from both heroin and prescription opioids.
The occupation groups with the highest PMRs from methadone, natural and semisynthetic opioids, and synthetic opioids other than methadone were construction, extraction (e.g., mining, oil and gas extraction), and healthcare practitioners.
Data for the study were collected from 21 U.S. states participating in the National Occupational Mortality Surveillance (NOMS) system during 2007–2012. Overall, the CDC researchers identified 57,810 drug overdose deaths within the study population.
Relationship to Injury
Because of the elevated level of overdose deaths in the construction sector, the CDC attempted to find a relationship between opioid initiation or use and the work environment.
“A single on-the-job injury (e.g., fracture or dislocation) or chronic work-related pain (e.g., caused by repetitive motion or lifting) might result in a prescription for pain medication,” the CDC states. “Workers’ compensation data from 26 states (2013–2015) indicated that opioids were prescribed for 52–80 percent of injured workers who received pain medications. Persons might also self-medicate or work in an environment with normative support for illicit drug use. An estimated 64.2 percent of self-reported illicit opioid users were employed full-time or part-time in 2016. As licit and illicit opioid users participate in the workforce, occupation might be an important factor in understanding and responding to the opioid epidemic.”
Specific Circumstances Hard to Pin Down
The CDC noted that the study faced multiple limitations and generated more questions than answers. For example, while the study identified occupation groups with a higher proportion of drug and opioid-specific overdose mortality, the researchers were unable to identify specific factors that might have led to the observed results. Also, the NOMS provides limited information on the specific circumstances of death. The available data do not indicate whether the death occurred at work. Also, death certificates do not state whether the deceased were employed at their usual job (listed on the death certificate), another job, or unemployed at the time of death; if the drug use was legal or illegal; or if drug use was initiated while the deceased were employed at their usual job, another job, or before employment. Moreover, the specific drug involved in the drug overdose death might have been misclassified (e.g., heroin deaths misclassified as morphine deaths because of similar metabolites) or given nonspecific codes. Within this study, the only drug code listed for one-fourth of overdose deaths was “other and unspecified drugs.”
More Studies Needed
The CDC emphasizes that future studies are needed to identify potential work-related factors along the pathway from drug initiation to overdose mortality and also to investigate ways of tailoring prevention measures to specific occupations.
“Workplace-specific programs and policies to reduce the impact of the opioid epidemic can be implemented,” says the CDC. “Since 2009, a decline in opioid use among nonsurgical workers’ compensation claims in 26 states has occurred, which is associated with changes to workers’ compensation laws and regulations regarding pain management and the prescribing and distribution of opioids, in addition to corresponding national and state-level legislative and regulatory changes.
Examples of programs that might address both licit and illicit opioids include comprehensive drug-free workplace programs, employee assistance programs, peer-support networks, and education targeted to employees and employers.
“Continued evaluation of the effectiveness and impact of these programs and interventions are needed to prevent opioid misuse and abuse and to reduce opioid-related morbidity and mortality,” says the CDC.
The CDC study, which includes a detailed breakdown of overdose death by occupation, is at https://www.cdc.gov/mmwr/volumes/67/wr/mm6733a3.htm?s_cid=mm6733a3_w.