Rousmaniere: Work Injury Risk — Driving Opioid Deaths?

Massachusetts has come up with a provocative study about opioid-related deaths, in which the authors appear to be believe that physically hard, financially insecure work is an important contributor to opioid-related deaths. Let’s dig into their analysis. 

How bad is the problem of opioid-related deaths?

The Massachusetts Department of Public Health issued a report this month entitled, “Opioid-related Overdose Deaths in Massachusetts by Industry and Occupation, 2011-2015.”  The estimated number of opioid-related overdose deaths in the state more than doubled from 2011 and 2015, and the rate of opioid-related overdose death is higher than the average for the nation. There were a total of 5,580 opioid-related overdose deaths in Massachusetts from 2011 through 2015.

Did the rate of deaths vary by occupation?

Very much so. It found that the rate of fatal opioid overdose varied significantly by industry and occupation. Construction and extraction workers had both a high rate (150.6 deaths per 100,000 workers) and a high number of opioid-related overdose deaths, 1,096 or 24% of all opioid-related deaths. 

The rate for construction only was 124.9 per 100,000 workers;  accommodation and food services, 36.5;  health care and social assistance, 9.7%; manufacturing, 8.0%; and educational services, 4.3, to cite a few industries. The wide variance among major workforce sectors means that a statewide average is virtually meaningless as a benchmark for understanding the opioid crisis. 

Why do rates vary?

The authors of the report wrote that “Understanding the many complex factors contributing to the opioid epidemic is very challenging.” For perhaps value-driven reasons, they decided to find answers in job-related stress factors, including “work-related injuries, job insecurity, access to paid-sick leave, and other occupational and socioeconomic factors.” They did not look at any variance in substance abuse rates among the workforce sectors.

How much do work injuries matter?

The authors made a reasonable hypothesis that the rate of work injuries is causally associated with opioid-related deaths. For them the actual work injury event was not as important as the possibility that a high injury rate is a sign of persistent pain brought or aggravated by work and driving the worker to find relief.

They estimated that workers within occupation groups with fewer than 50 injuries per 10,000 full-time workers had an opioid-related overdose death rate of 9.0 per 100,000, while workers within occupations with 200 or more injuries and illnesses per 10,000 workers had an opioid-related overdose death rate of 68.4.

What about pain-related distress?

They looked at “job insecurity and availability of paid sick leave, both of which have potential to increase the need to work while in pain and may increase reliance on pain medication. A significantly higher death rate was observed among workers in occupation groups with high job insecurity compared with workers in occupation groups with low job insecurity.” They reason that job insecurity complicates the worker’s effort managing his pain successfully (men overwhelmingly dominated the ranks of construction workers who died).

What about the impact of medical treatment?

One possible trail of breadcrumbs they did acknowledge, but did not pursue at length, was the possibility that work injury treatment involved a great deal of opioid-prescribing. Persistent pain would not be the contributing cause so much as the particular style of medical care for the pain. But they did not look at opioid prescribing for non-work related musculoskeletal pain.

What about underlying substance abuse?

The authors appear to have disregarded the possible role of substance abuse as a contributor to opioid-related deaths. Perhaps they did not pursue this line because substance abuse patterns fail to correlate tightly with work injury. The National Safety Council and other organizations have analyzed the variance of substance abuse by workforce sector. Illicit drug users as a percentage of workers varies in ways not consistent with work injury risk and pain from work: construction, 11.6%; accommodation and food services, 19.1%; arts, entertainment and recreation 13.7%; and healthcare and social assistance. 5.5%.

The National Safety Council’s estimates of the cost of substance abuse to employers matches up with illicit drug use. The Council says that per one hundred workers in Massachusetts, substance abuse in construction costs $46,000; in “entertainment, recreation, and food,” $44,000; and in education, health and social services $26,000.

Are work injuries an accelerant? 

A speculation emerges that workforce with both a high work injury rate, particularly musculoskeletal in nature, and a high incidence of substance abuse may lead to very high risk of opioid-related deaths.

ABOUT THE AUTHOR

Peter Rousmaniere is widely known throughout the workers’ compensation industry, both for his writing and consulting experience. Based in the picture perfect New England town of Woodstock, VT, he is a regular on the conference circuit, and is deeply in tune with trends and developments within the industry. His passion is writing and presenting on issues largely related to immigration, and he maintains a blog on the subject at www.workingimmigrants.com.

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