Rehab and Community Care Medicine Winter 2024: Injured workers have higher rates of opioid poisonings

New study by the Institute for Work & Health and Occupational Cancer Research Centre also identifies occupations with the highest risks of opioid-related poisonings and other harms.

People who have previously experienced a work-related injury are more likely to experience opioid poisonings and other opioid-related harms than the general population. That’s according to research conducted by the Institute for Work & Health (IWH) and the Occupational Cancer Research Centre (OCRC), using data from 1.7 million Ontario workers who had an accepted lost-time workers’ compensation claim between 1983 and 2019.

The study found higher rates of opioid-related harms in this group of formerly injured workers than in the general population. Opioid-related harms refer to poisonings and mental and behavioural disorders, such as those related to withdrawal and dependence. Within the sample of injured workers, several occupational groups had greater risks of opioid-related harms. These included construction, forestry and logging, materials handling, machining, and processing. In some occupational groups, higher risks were found only in specific occupations. Examples included nursing aides, janitors and cleaners, and security guards.

“Our results suggest that work-related injuries are associated with increased future risk of opioid harms,” says Dr. Jeavana Sritharan, OCRC scientist and co-author of a pair of peer-reviewed journal articles on the study. The first paper was published in April, in the Canadian Journal of Public Health the second was published in Occupational and Environmental Medicine.

“Part of the reason may be that workers in physically demanding jobs make up a disproportionate share of injured workers,” says Dr. Nancy Carnide, IWH scientist and study co-author. “But part of the reason may also be related to the experience of being injured and recovering from a work injury.”

The study drew on the Occupational Disease Surveillance System (ODSS), which links records from the Workplace Safety and Insurance Board with health-care data to identify hospitalizations and emergency department visits for opioid-related harms that occurred from 2006 to 2020. Some of the data from this study can be explored via a data visualization tool, which breaks down cases and rates of opioid poisonings (or overdoses) and other harms by age, sex, Ontario region, occupation, and industry.

The large dataset that the study drew on gave the research team a unique opportunity to examine which industries and occupations face higher risks of opioid harms. “These results can be used by policy-makers and workplaces to target prevention and harm reduction activities,” says Carnide.

1. Compared to the general working-aged Ontario population, emergency department visits for opioid poisonings were 2.4 times higher among formerly injured workers in the Occupational Disease Surveillance System (ODSS); hospitalization rates were 1.5 times higher.

2. All industries and almost all occupation groups in the ODSS had elevated risks of opioid-related poisonings.

3. Emergency department visits due to 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, and 2.6 times as high in machining occupations.

4. Compared to other formerly injured workers in the ODSS, those at highest risks of opioid poisonings worked in construction (57 per cent higher), forestry and logging (45 per cent higher) and materials handling (32 per cent higher).

5. Within broad occupational groups, differences in risk were found for some specific occupations. In construction, for example, workers in excavating, paving, and grading, as well as other trades (e.g., roofers, painters, brick and stone masons) had higher risks of harms. In contrast, workers in electrical trades had lower risks of harms.

6. Increased risks of opioid harms were also seen in specific occupations such as: horticultural nursery workers; service station attendants; guards and watchmen; nursing aides and orderlies; tellers and cashiers; lodging occupations; chefs and cooks; waiters, hostesses and stewards; personal service and other service occupations (namely janitors and cleaners); metal, wood and other fabricating occupations; bookbinders; and stationary engine and utilities operating.

This study was co-authored by Dr Nancy Carnide, Institute of Work & Health and Dr. Jeavana Sritharan, scientist at the Occupational cancer Research Centre.