Opioid overdose is now the leading cause of death for Americans under 50. This is a staggering statistic reflecting a national public health emergency.

A study released this month by the Massachusetts Department of Public Health  reported that construction workers, farmers and fisherman are particularly at risk with higher than average rates of overdose deaths. The opioid-related death rate for employees in the construction and extraction industries was six times the average for all Massachusetts workers. Other occupations with significantly higher than average rates of opioid related deaths among Massachusetts workers included: material moving; installation, maintenance, and repair; transportation; production; food preparation and service; building and grounds maintenance and health care support.

What all of these occupations have in common is that they have a particularly rate of workplace injuries.

The report documents a disturbing trend of workers becoming addicted to painkillers after being hurt on the job. Opioids are frequently prescribed for pain management following a work-related injury.

The Massachusetts finding is consistent with a report from Utah which found that 57% of those who died from an opioid overdose had suffered a work-related injury at some point in their life. It is also consistent with estimates compiled by the Midwest Economic Policy Institute which reports nearly 1,000 construction workers across seven Midwestern states died from opioid related overdoses in 2015.

These findings underscore the importance of employers developing educational and policy initiatives targeting high risk populations to prevent opioid-related deaths. These initiatives should include addressing workplace conditions that cause injuries for which opioids are prescribed, pain management education following injury including information about safer opioid prescribing practices, and access to evidence-based treatment for opioid used disorders.

According to a recent statement  by the Massachusetts Public Health Commissioner, Dr. Monica Bharel: “Ensuring that jobs are safe, that the risk of injury is low, and that workers have time for rehabilitation and are not self-medicating to keep working are all key to decreasing opioid overdose deaths among workers.”

In a previous post I noted that the American Academy of Family Physicians, while recognizing that opioid therapy benefits some patients with chronic pain, is urging its members to discuss the risks and benefits in a much more detailed way with patients and issue these explicit warnings:

• “This medicine is usually used to relieve pain. But if you take it every day for a long time, it can make your pain worse. It can even cause pain in parts of your body where you didn’t have pain before.”
• “When you first start taking this medicine, it will probably work well to reduce your pain. But if you take it every day for a long time—weeks to months—it may stop working. You may find that after a while, your pain is as bad as before you started the medicine.”
• “Your body may become dependent on this medicine. That means that if you don’t take it or you take less than your usual amount, you may experience withdrawal. Withdrawal can feel like a bad case of the flu, including hot and cold sweats, diarrhea, feeling like you need to throw up, not being able to sleep, and feeling down or nervous. You may also have aches all over your body. For some people, withdrawal makes them feel like they might die. But people rarely die from opioid withdrawal.”
• “This medicine can kill you by slowing down your breathing and your heart rate until you stop breathing and your heart stops beating. The more you take, the more likely this is to occur, even if you’ve been taking it the same way for a long time. The risk increases if you take this medicine with alcohol or other drugs that cause sleepiness. Also, if you take high doses of this medicine after you haven’t taken it for awhile, you are at increased risk of overdose because your body loses the ability to tolerate high doses.”

Fortunately, there is a great deal of research now into a wide range of non-drug and non-invasive treatments which are proving effective in relieving many chronic pain problems.

Employers should take advantage of the expertise of their EAPs and collaboratively develop plans to ensure that employees have access to accurate information about addiction, addiction treatment, and alternative pain therapies. It is, most literally, a matter of life and death.