Opioids and the Workplace

This is a First Look at a column to appear in the June 2019 issue of
Water Well Journal

A significant problem everywhere, opioids can increase workplace accidents.

By Alexandra Walsh

The National Safety Council recently reported that for the first time on record the odds of dying from an unintentional opioid overdose (1 in 96) are greater than the lifetime odds of dying in a motor vehicle-related crash (1 in 103).

Although that may seem shocking, opioid overdoses have been at an epidemic level in the United States for years. In fact, drug poisoning is the number one cause of unintentional death. The NSC notes more than 100 people die from opioid drugs every day!—close to 38,000 people every year—and many of these overdoses are from prescription opioid medicine.

A Workplace Problem

When used correctly, prescription medication is an essential part of an employee health care benefits package. However, as the NSC notes, opioid medications are powerful, highly addictive, and increase the risk of workplace incidents and injuries—even when they are used as prescribed.

Prescription painkillers also profoundly increase workers’ compensation costs, increase the length of worker disability, and increase work time lost, according to the NSC.

Robert Redfield, M.D., who is Director of the Centers for Disease Control and Prevention, says: “The opioid epidemic reaches into every aspect of American life—including the workplace. CDC is working to understand the impact of different technologies to minimize risk and protect our nation’s workers and responders.”

Here are just a few sobering statistics on opioid use in the workplace compiled by the CDC’s National Institute for Occupational Safety and Health (NIOSH).

  • In 2017, 95% of the 70,067 U.S. drug overdose deaths occurred among the working-age population, people 15 to 64 years old.
  • The 272 workplace overdose deaths reported in 2017 accounted for 5.3% of occupational injury deaths that year, as compared to 1.8% in 2013.
  • According to the federal National Survey of Drug Use and Health, an estimated 4.3% of respondents age 18 or older reported illicit opioid use in the past year. An estimated 66.7% of these self-reported illicit opioid users were employed full-time or part-time.
  • The Bureau of Labor Statistics reported overdose deaths at work from non-medical use of drugs or alcohol increased by at least 25% annually between 2013 and 2017.
  • According to the BLS, overdose deaths in the workplace from non-medical use of drugs or alcohol increased by at least 38% each year between 2013 and 2016. New analysis from CDC’s Morbidity and Mortality Weekly Report found certain job groups, such as construction or extraction, may have a higher risk of death from opioids.
  • Workers with a current substance use disorder miss an average of 14.8 days per year, while workers with a pain medication use disorder miss an average of 29 days per year. This contrasts with an average of 10.5 days for most employees, and an average 9.5 days for workers in recovery from a substance use disorder.

NIOSH began developing a framework in 2018 that approaches the opioid crisis from a workplace perspective. It examines different working conditions that can pose risk factors for medically prescribed opioid use becoming opioid misuse or abuse.

Once the framework is developed into a CDC program, it will:

  • Provide guidance for employers and medical providers serving workers to prevent medically prescribed opioid use from becoming an opioid use disorder
  • Recommend education workers need regarding the risks of opioid use
  • Outline how workers exposed to opioids and overdoses as part of their job can be protected
  • Provide guidance on safely and accurately detecting opioids present in the workplace and safeguard workers who must decontaminate these spaces
  • Outline which work-related factors such as injuries, pain, job loss, and stress may be leading to the use and abuse of opioids.

Workplace Risk Factors

Opioids are often initially prescribed to manage pain arising from a work injury. Risky workplace conditions that lead to injury (slip, trip, and fall hazards or heavy workloads) can be associated with prescription opioid use.

Other factors such as job insecurity, job loss, and high-demand/low-control jobs may also be associated with prescription opioid use. It has been stated that prescription opioid misuse can also lead to heroin use.

NIOSH states recent studies show higher opioid overdose death rates among workers in industries and occupations with high rates of work-related injuries and illnesses.

Rates also were higher in occupations with lower availability of paid sick leave and lower job security. This suggests the need to return to work soon after an injury may contribute to high rates of opioid-related overdose deaths.

In addition to work injuries and illnesses being the reason opioids are prescribed in the first place, there are other ways in which this epidemic is undoubtedly impacting workers and employers, according to NIOSH. The use of prescription opioids may impact the ability of a person to return to work, and ultimately negatively affect the longevity of their livelihood.

If workers are under the influence of opioids while they are at work, they are likely to be at increased risk for injury. For workers in safety-sensitive jobs such as operators of heavy equipment like a drill rig, there is an increased risk for catastrophic accidents that impact many people besides the worker.

What Employers Can Do

It is not commonly known that non-opioids have been shown to be as effective as opioid medications for pain, the NSC states. Employers should understand and insist upon conservative prescription guidelines for pain treatment for all participating providers in their medical, workers’ comp, and occupational health programs.

The NSC recommends workplaces follow these steps to help combat opioid abuse at work:

  • Establish a clear, written policy on prescription medication. For example, your policy may stipulate it is a violation for workers to use, possess, sell, trade, or offer for sale alcohol, illegal drugs, or intoxicants. NSC recommends consulting with legal counsel to ensure all federal- and state-specific guidelines are reflected in your policy.
  • Educate workers. Although the doctor-patient relationship is confidential, employees should be encouraged to discuss concerns with their employers about taking prescribed opioid painkillers. Employees then should work with their doctor to determine if a non-opioid prescription can be used instead.
  • Train supervisors. It is crucial managers stay current on their workplace’s policies for prescription drug use and understand signs of impairment in their workers.
  • Offer an Employee Assistance Program. Promoting drug-free workplace initiatives increases employees using these resources. Employers should feel comfortable advocating EAPs.
  • Consider drug testing. Drug-testing programs must address non-medical drug and prescription drug abuse in the workplace, according to NSC. Although most employees use prescription medications correctly, some do not.

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It is obvious how significant a problem opioids are, not only at home but in the workplace. Rather than being overwhelmed by the shocking statistics describing opioid overdoses, employers and employees alike must pay attention, recognize—and more importantly, help solve—the opioids problem.


Alexandra Walsh is the vice president of Association Vision, a Washington, D.C.–area communications company. She has extensive experience in management positions with a range of organizations.