Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths — United States, 2007–2012

Abstract

The opioid epidemic affects multiple segments of the U.S. population (1). Occupational patterns might be critical to understanding the epidemic. Opioids are often prescribed for specific types of work-related injuries, which vary by occupation* (2). CDC used mortality data from the National Occupational Mortality Surveillance (NOMS) system to examine unintentional or undetermined drug overdose mortality within 26 occupation groups. This study included data from the 21 U.S. states participating in NOMS during 2007–2012.† Drug overdose mortality was compared with total mortality using proportional mortality ratios (PMRs) indirectly standardized for age, sex, race, year, and state. Mortality patterns specific to opioid-related overdose deaths were also assessed. Construction occupations had the highest PMRs for drug overdose deaths and for both heroin-related and prescription opioid–related overdose deaths. The occupation groups with the highest PMRs from methadone, natural and semisynthetic opioids, and synthetic opioids other than methadone were construction, extraction (e.g., mining, oil and gas extraction), and health care practitioners. The workplace is an integral part of life for the majority of the adult U.S. population; incorporating workplace research and interventions likely will benefit the opioid epidemic response.

Prescription opioid use and associated factors among US construction workers

“…Table 3 The higher odds of prescribed opioid use among injured construction workers could be one of the major factors underlying the higher prevalence of opioid use and the higher rate of opioid-related overdose deaths in construction occupations that have been previously reported. 16,17,32 Construction is one of the industries with high risks of injury at worksites. The rates of work-related fatal and nonfatal injuries are consistently higher than most industry sectors and the overall workforce in the United States.…”

“…14 Studies also found that construction workers were more likely to use opioids and die of opioid-related overdoses than workers in other industries. [15][16][17][18][19][20] Furthermore, workplace overdose fatalities in the construction industry increased ninefold from 2011 to 2018, double the increase in all industries combined during the same period. 21 In response to this opioid crisis in the workplace, a great number of studies have been done through various approaches.…”

Mortality of older construction and craft workers employed at department of energy nuclear sites: Follow‐up through 2016

“…Of the 41 deaths 19 were assigned code X44 (Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances), 16 were assigned code X42 (accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified) and three were assigned code X45 (Accidental poisoning by and exposure to alcohol). While it is not possible for us to establish with certainty what this increase may be associated with, it is likely an early effect of the opioid epidemic that is raging through the US, including the construction trades . A recent study of mortality from this cause in Massachusetts found that construction trades workers accounted for the largest number of deaths from opioid poisoning, totaling 26.8% of all such deaths, for a rate of death more than six times higher than all occupations combined.…”

Influence of work organization and work environment on missed work, productivity, and use of pain medications among construction apprentices

“…While we cannot be certain what medications were prescribed for pain, it is highly likely that most of these prescriptions were for opioids. The disproportionately high rates of use and overdose of opioids seen in the construction industry likely rise from several causes, including high rates of injury and subsequent medical care among construction workers, the intermittent nature of construction work, and the lack of paid sick leave: the need to return to work soon after an injury or to work while in pain may contribute to high rates of opioid use among construction workers and workers in other occupations with lower availability of paid sick leave and lower job security…”

“…The use of pain medication is relevant to employers due to increasing evidence that construction workers are at a uniquely high risk of opioid use and overdose, and to increase recognition by the construction industry of the need for improved prevention of opioid use disorder. Recent studies have shown that construction workers and miners are more likely than workers in other industries to be prescribed opioids and to receive prescriptions for longer periods of time, and that construction workers and miners are at markedly high risk of opioid overdose fatalities (up to six times the rate of overdose fatalities compared to the general workforce in Massachusetts) . There is growing awareness and calls for action among construction employers and safety professionals for action to reduce the high personal and economic costs of opioid use in this industry…”