It Is Time to Implement Primary Prevention in the Workplace to Ameliorate the Ongoing U.S. Opioid Epidemic

Abstract

The United States’ opioid public health crisis continues having disastrous consequences on communities, including workers and employers. From May 2019 to May 2020, the largest number of drug overdose deaths was recorded over a twelve-month period. The “twindemics” of COVID-19 and opioids underscore the urgent need to address workers’ physical and mental health. Although much has been written about the negative impacts of the opioid epidemic on the workplace, few initiatives have focused on primary prevention, addressing work-related root causes of opioid use disorders (e.g., injury, stress) that may lead to prescription or illicit opioid use. We suggest primary prevention efforts to address the connection between workplace hazards and opioid misuse, dependence, and addiction such as examining patterns of work injury and stress with records of opioid prescription. Government funding should be expanded to support primary prevention and research efforts to strengthen the evidence-base to support workplace primary prevention endeavors.

The Relationship Between Workplace Drug Policies, Opioid Misuse, and Psychological Distress: Evidence From the 2020 National Survey on Drug Use and Health

“… 34 – 38 The COVID-19 pandemic exacerbated the ongoing opioid epidemic and its interrelationship with psychological distress in the workplace, prompting calls for action from policy makers, business leaders, employers, and workers to take stock of how mental well-being is addressed in the workplace. 39 – 41 Though some employers may believe that workplace drug testing policies are net-beneficial to workplace well-being because they reduce physical hazards, such as drug-related workplace accidents and illnesses, 17 this study's findings indicate that such policies may simultaneously interact in harmful ways with psychological distress and are not universally associated with lower opioid misuse among workers. The net result of workplace drug policies may harm worker well-being more than they help.…”

“… 56 , 57 From a primary prevention perspective, employers and professionals who oversee workplace health (e.g., industrial hygiene [IH] or occupational and environmental health and safety [OEHS] professionals) should conduct worksite ergonomics assessments to reduce the musculoskeletal disorders (MSDs) which may lead to chronic pain, opioid prescription, and potential opioid use/misuse disorders. 39 , 58 , 59 Robust primary prevention may include: establishing formal ergonomics programs to prevent musculoskeletal disorders; using administrative controls, such as scheduling, to limit workload so as to not overburden workers; and addressing negative psychosocial factors (e.g., low supervisor support, high job demands, low job autonomy) that research has demonstrated does indeed affect workers’ mental and physical health outcomes, especially in relation to musculoskeletal disorders incidence. 39 , 59 – 62 Workers’ compensation programs can make important contributions to secondary prevention by continuing to place limits on the quantity and circumstances under which providers can prescribe opioids and can require employers to shoulder the costs of nonpharmacological pain management approaches (e.g., physical therapy, acupuncture, massage therapy, etc.)…”

“… 39 , 58 , 59 Robust primary prevention may include: establishing formal ergonomics programs to prevent musculoskeletal disorders; using administrative controls, such as scheduling, to limit workload so as to not overburden workers; and addressing negative psychosocial factors (e.g., low supervisor support, high job demands, low job autonomy) that research has demonstrated does indeed affect workers’ mental and physical health outcomes, especially in relation to musculoskeletal disorders incidence. 39 , 59 – 62 Workers’ compensation programs can make important contributions to secondary prevention by continuing to place limits on the quantity and circumstances under which providers can prescribe opioids and can require employers to shoulder the costs of nonpharmacological pain management approaches (e.g., physical therapy, acupuncture, massage therapy, etc.) to address acute and chronic pain caused by work-related injuries.…”

“…using administrative controls, such as scheduling, to limit workload so as to not overburden workers; and addressing negative psychosocial factors (e.g., low supervisor support, high job demands, low job autonomy) that research has demonstrated does indeed affect workers’ mental and physical health outcomes, especially in relation to musculoskeletal disorders incidence. 39 , 59 – 62…”

“…56,57 From a primary prevention perspective, employers and professionals who oversee workplace health (e.g., industrial hygiene [IH] or occupational and environmental health and safety [OEHS] professionals) should conduct worksite ergonomics assessments to reduce the musculoskeletal disorders (MSDs) which may lead to chronic pain, opioid prescription, and potential opioid use/misuse disorders. 39,58,59 Robust primary prevention may include:…”