Formerly injured workers more likely to suffer opioid-related harms: study

Sadly, opioids continue to make headlines. A quick search of Google news, for example, shows that Alberta had its highest opioid-related death totals on record in 2023, while a class-action lawsuit was recently authorized to proceed in Quebec against 16 pharmaceutical companies for their role in manufacturing, selling, marketing and distributing opioid drugs.

This is just a taste of what Ottawa calls a “public health crisis” that is having “a tragic impact on people who use substances, their families, and communities across the country.”

As further proof of the growing problem: From January to September 2023, there were 5,975 apparent opioid toxicity deaths in Canada — or 22 deaths per day — which is eight per cent higher than 2022, says the federal government. There were also 4,646 opioid-related poisoning hospitalizations (13% higher than 2022) and 21,708 opioid-related poisoning emergency department visits (14% higher than in 2022).

It’s an issue that should definitely be on the radar of employers and HR, since many employees are suffering from opioid harm.

Researching work injuries’ relation to opioid harm

To better understand the issue, Canadian researchers with the Institute of Work and Health (IWH) recently looked at the role of work-related injuries as a risk factor for opioid-related harms in Ontario.

They examined workers’ compensation claimants (1983–2019) and linked them to emergency department (ED) and hospitalization records (2006–2020).

The results? “Work-related injuries have a role as a preventable risk factor for opioid-related harms,” says the study in the Canadian Journal of Public Health, which states that in both Canada and the U.S., anywhere from 20% to 40% of opioid-related deaths with available employment status information have occurred among working adults.

The IWH researchers found that compared to the general population, between 2006 and 2020, opioid-related poisonings (often known as overdoses) and mental and behavioural disorders (such as dependence, withdrawal and intoxication) were more likely to occur among formerly injured workers.

For opioid-related poisonings, the risk of emergency department visits was 2.4 times higher, and hospitalizations were 1.5 times higher than the general population

For opioid-related mental and behavioural disorders, the risk of emergency department visits was almost twice as high, and hospitalizations were 1.4 times as high among this group of formerly injured workers, compared to the general population.

Much-needed data to understand opioid harms

“It's a unique study, and I think that it does underscore how important injury prevention is and how work-related injuries are related to opioid harms,” says Jeavana Sritharan, co-author and scientist at the Occupational Cancer Research Centre.

There’s not much evidence in in Canada that looks at this particular topic, she says, “so we've got this diverse workforce, we're able to look at multiple groups, and what we're seeing is that some of these groups have two times the risk or over 1.5 times the risk, which is significant for us.

“We have multiple analyses, this one is really comparing to the general population, and what it tells us is that these workers are at a higher risk of opioid-related harms… It fills an important research gap.”

This kind of data is also important for employers, says Nancy Carnide, co-author and scientist at IWH.

“We haven't had a lot of research in a Canadian context to be able to support the notion that this is an issue in the workforce. So, we hope that this information, the data that we are collecting and disseminating, will bring more awareness to employers that this is something that needs to be addressed, and that workplaces really can play a role in in helping in this crisis.”

Occupational hazards to substance harm

The two researchers found that all industries and almost all occupation groups in Ontario had elevated risks of opioid-related poisonings. Compared to the general population, emergency department visits for poisonings among formerly injured workers were:

• more than three times as high for those in construction
• 2.8 times as high in materials handling
• 2.7 times as high in mineral, metal or chemical processing
• 2.6 times as high in machine-related occupations.

Similar numbers were found for all industries and almost all occupational groups when it came to opioid-related mental and behavioural disorders compared to the general population.

While there are limitations to how the study was done, such as matching on the type of occupation in the comparison group, the results are consistent with limited data seen out of the U.S. around the potential role of work injury and opioid harms, says Carnide.

“And it's also consistent with what we see in terms of the occupational patterns from U.S. data around who is being affected — it tends to be those physically demanding occupations.”

Understandably, industries such as construction jobs saw higher risks, says Sritharan.

“But I think we were just surprised at how many groups had these higher risks compared to the general population — and the magnitude of the risks.”

Also notable? The research shows there are also slightly higher risks for service workers and employees in medicine and health.

“The surprise, potentially, here [is] that most of the occupational groups were at greater risk — even the ones that we don't traditionally see in some of the previous literature out of the U.S. So, things like clerical jobs, as an example,” says Carnide.

“But, again, the unifying factor in this group of workers is that they've all experienced some sort of work-related injury.”

Effective June 1, 2023, companies in Ontario must have a naloxone kit available if there is a risk of a worker experiencing an overdose from fentanyl, oxycodone or other opioids at the workplace.

Preventing injuries, supporting return to work to avoid opioid risks

Given the data, how should employer be responding?

Clearly, the primary prevention of the injury itself is important, says Carnide. “That's obviously a goal that workplaces have been striving for for a long time — that's a longstanding issue.”

Strategies aimed at preventing occupational injuries can include improving ergonomics, reducing physical and psychosocial hazards in the workplace, and educating workers on injury risk factors, say the researchers.

Also important: Targeting prevention of work disability and long-term opioid use (such as “judicious prescribing,” access to effective non-opioid treatments for pain, mental health supports, availability of sick leave, work accommodations, and educating workers on the risks of opioid use).

These particular workers also face challenges that make them more vulnerable to experiencing opioid-related harms, say Carnide and Sritharan, citing previous studies that have shown the pressure to return to work after an injury and lack of suitable workplace accommodations, potentially make it more likely they will use opioids to manage residual pain.

“Certainly, after an injury, those supports need to be in place in terms of allowing sufficient time for recovery, providing appropriate work accommodations, for someone who's trying to return to work, mental health supports,” says Carnide.

Combatting stigma of issues with pain, substance use

Being able to talk about this issue within the workplace, and the stigma around that, is also important, according to Sritharan, so both workers and employers understand how the risks are related to previously injured workers.

“I think that's the biggest [insight] from our project is the awareness that this is a problem that exists, and there needs to be more discussion on this, depending on who's involved in the workplace, whether it be HR or other counterparts.”

Tackling the stigma head-on is key, says Carnide, “and enabling an environment where workers can feel comfortable coming forward to disclose any issues they may be having, whether that be with a substance use disorder, or even pain [where] they just can't seem to be able to get through the day.

“Just feeling that they can come forward without worrying about the repercussions on their job.”

Peer support can also be valuable, says Sritharan, especially among the different occupations.

“We hear from different groups of workers [who say] there's a series of supports that need to be in place for them to be effective, especially if they're returning to work after an injury.”

Communication key, says Carnide, between the employer and the employee, so people are comfortable deciding when they should go back to work.

“It also includes communication with the healthcare providers, ensuring that everyone is onboard and everyone feels that this is the right plan going forward…. making sure everybody is on the same page.”