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Work-related injuries are a preventable risk factor for opioid-related harms, new research from Ontario, Canada, suggested.

An analysis of close to 1.7 million formerly injured workers in almost all occupational groups in Ontario's Occupational Disease Surveillance System (ODSS) revealed elevated risks for opioid-related poisonings and behavioral disorders compared with the general population.

Higher-risk industries included construction; materials handling; processing of minerals, metals, and chemicals; and machining, among others.

"We weren't necessarily surprised by the overall findings…but we weren't anticipating the magnitude of those risk estimates," lead author Nancy Carnide, PhD, a scientist at the Institute for Work and Health, and Jeavana Sritharan, PhD, a scientist at the Occupational Cancer Research Centre, both in Toronto, Ontario, Canada, told Medscape Medical News. 

The researchers expected that the highest risks would be among those in physically demanding jobs. However, they said, among the formerly injured workers, "virtually all occupational groups demonstrated increased risks, which was something we weren't expecting to find."

The study was published online on April 24, 2024, in the Canadian Journal of Public Health.

Most Workers Affected 

To estimate incident rates of opioid-related poisonings and mental and behavioral disorders among formerly injured workers and the general population, the researchers linked workers' compensation claimants (1983-2019) in the ODSS to emergency department (ED) and hospitalization records (2006-2020). 

Most workers in the ODSS (80.9%) were at least 35 years old and male (66.3%). In contrast, two thirds of the general population were at least 35 years old, and half were male. The researchers calculated standardized incidence ratios (SIRs), adjusting for age, sex, year, and region.

Compared with the rate in the general population, opioid-related poisonings in the ODSS group were higher in both ED (SIR = 2.41) and hospitalization records (SIR = 1.54).

Almost all occupational groups in the ODSS had higher risks for opioid-related poisonings compared with the general population. As noted earlier, some of the highest SIRs were among those in construction trades (SIR = 3.16), materials handling (SIR = 2.84), processing (mineral, metal, chemical; SIR = 2.72), and machining and related (SIR = 2.61) occupations. 

Higher risks were also seen in service, medicine and health, sales, and processing (food, wood, and textile) occupations. Teaching and related occupations, however, had a reduced risk for opioid-related poisonings compared with the general population, based on ED and hospitalization data (SIR = 0.73 and 0.40, respectively). 

Opioid-related mental and behavioral disorders were also higher in the ODSS group (ED visits, SIR = 1.86; hospitalizations, SIR = 1.42), and as shown with poisonings, almost all occupational groups had higher risks.

Sex Difference 

Subgroup analyses showed the risk for opioid-related poisonings among female workers in the ODSS was higher than that among women in the general population in ED (SIR = 2.83) and hospitalization records (SIR = 1.60). Results were similar for males (ED visits, SIR = 2.30; hospitalizations, SIR = 1.52).

Likewise, the risk for opioid-related mental and behavioral disorders was higher among female workers in the ODSS (ED visits, SIR = 1.73; hospitalizations, SIR = 1.33) and males (ED visits, SIR = 1.90; hospitalizations, SIR = 1.46).

Although the patterns of findings by occupation and industry among men and women resembled those of the main analysis, in most cases, SIR estimates were higher among women than among men.

"Findings support the hypothesis that work-related injuries have a role as a preventable risk factor for opioid-related harms," wrote the authors. "Strategies aimed at primary prevention of occupational injuries and secondary prevention of work disability and long-term opioid use are warranted."

"This work is important not only for workers but also their family and friends, employers, the wider community, and the healthcare system, as we are all impacted by this growing public health crisis," said Carnide and Sritharan.

"When a worker does experience an injury, post-injury supports are important," they added. "These may include timely access to medical care and rehabilitation services, the provision of nonopioid pain management, and workplace supports that enable a safe return to work to avoid aggravating the original injury." 

Prescribing of opioids, when necessary, should follow clinical guidelines, they noted, "and workers would benefit from education on the potential risks of use."

Economic, Cultural Pressures

Commenting on the study for Medscape Medical News, Samuel R. Friedman, PhD, research professor at the Center for Opioid Epidemiology and Policy in the Department of Population Health, NYU Grossman School of Medicine in New York City, said, "This is a well-done study with important findings. The importance of workplaces in public health is frequently underrated. Public health schools and practitioners and research funding bodies should pay more attention to these issues and their upstream causes and solutions." Friedman did not participate in the research. 

"Workplace injuries are often the result of economic and cultural pressures that lead employers to speed up work, introduce dangerous innovations, or force workers to work when they are too tired to do so safely," said Friedman, who discussed these pressures in an earlier article. 

The current study "would be more useful if it discussed these issues and also discussed how unions and shop floor rank-and-file groups can take actions to protect worker safety even when employers are opposed," he said.

In addition, he noted, in their discussion of why women seem to be at higher risk for overdose or other opioid-related harms, the authors did not consider "the stresses created by social subordination (akin to effects of such stressors on mortality rates of racial or ethnic minorities) and by the difficulties of dealing both with employment and inequitable amounts of household duties many women face. 

"It is notable that healthcare occupations have increased rates of opioid-related harms after injury," he added. "Clinicians and hospital administrators should prioritize worker safety more, and clinicians should support the development of strong and effective unions at their workplaces. Further, when injuries occur, they should do everything they can to support the injured, along the lines that this and similar papers have pointed to."

The study was funded by the Public Health Agency of Canada. Carnide, Sritharan, and Friedman declared no relevant financial relationships. 

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.