‘Unprecedented public health crisis’: Pioneering research studies links between workplaces, opioid harms

Dr. Nancy Carnide (left) is a scientist at the Institute for Work & Health. Dr. Jeavana Sritharan is a Scientist at the Occupational Cancer Research Centre (OCRC) based at Ontario Health.

The opioid crisis is taking a devastating toll, with more than 40,000 opioid-related deaths reported by the Public Health Agency of Canada from January 2016 to June 2023.

Nancy Carnide of the Institute for Work and Health (IWH) pointed out that sobering statistic during her keynote presentation at the Opioids in the Workplace virtual event from OHS Canada and Talent Canada on Jan. 31 that attracted nearly 350 professionals.

“North America has been facing an unprecedented public health crisis related to opioid-related poisonings, which has worsened in the last several years,” she said.

Carnide was joined by Jeavana Sritharan of the Occupational Cancer Research Centre (OCRC) and they unveiled critical insights into the intertwining crises of opioid misuse and workplace hazards.

Their research, a collaborative effort between IWH and the OCRC, offers a revealing look at the occupational patterns in opioid-related harms in Ontario and underscores the urgent need for intervention strategies tailored to the working population.

Higher risk groups

Carnide noted that some groups are at higher risk — pointing out that “males of working age, prime working age, particularly those between the ages of 30 and 49 have been disproportionately affected.”

There are also occupational patterns that emerge in the data, she said, pointing to some U.S. studies.

“Across these studies, opioid-related poisonings have been particularly prominent among those in construction and trades, natural resources, transportation, maintenance, health care and services,” said Carnide, noting that many of those roles are physically demanding.

She pointed to one U.S. study that found 57% of those who died of an opioid poisoning had a lifetime history of work injury. Other data found that workers who had WCB claims for low-back pain had a 62% increased risk in dying from a poisoning compared to the general population.

Canadian data

Canadian-specific data is hard to come by, she said, adding “we know relatively little about how this crisis has affected the working population.”

Some of the most recent data on this side of the border came via coroner’s investigations, she said. It found that 13% to 16% of those who died from opioid poisonings in 2019-2020 were known to be employed at the time of death.

“This is certainly not a trivial proportion,” said Carnide, who also noted that about one-third of the people who died had an unknown employment status.

The construction sector had the highest proportion of workers (29.7%), she said.

Occupational Disease Surveillance System

Sritharan took the audience through the methodology of their study, emphasizing the unique approach of utilizing the Occupational Disease Surveillance System (ODSS) to monitor opioid-related harms.

This system allowed the researchers to track more than 1.7 million Ontario workers, identifying approximately 10,000 poisonings and 11,000 cases of mental and behavioral disorders attributable to opioid use.

The findings revealed elevated risks of opioid-related harms among workers, especially those in physically demanding jobs such as construction, trades, natural resources, and healthcare.

But Sritharan noted the risk isn’t uniform by industry — there are specific roles within construction and machining, for example, that have higher risks.

“When we dig deeper (into construction), we can identify specifically the higher risk groups being excavating, grading and paving workers and other construction trades,” she said. “This often includes roofers, boilermakers, et cetera.”

In machining, the roles at higher risk are metal shaping and forming, she said.

Interestingly, the data also identified workers at lower risk — such as electrical power, lighting, and wire communications in the construction sector; and metal machining in machining.

“This gives us an idea of where we actually see the higher risk groups — and who are the individuals who make up these higher risk groups compared to those of lower risk or where we don’t see an association,” said Sritharan.

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Carnide also noted an important caveat in their work.

“At the moment, we don’t have data on opioid use in the ODSS,” she said. That means they don’t know if the opioids that were used were prescribed by a physician or whether they were taking the drug for an injury or some other reason.

“So all of this is to say that while our results do suggest a potential role for work-related injuries as a risk factor for opioid-related harms, we can’t necessarily attribute the opioid harms in this cohort of workers to any opioids that were prescribed for the work injury that actually got them into our cohort,” said Carnide.

But what the data does provide is an “important signal” for which subgroups in the workforce might need more help, she said.

“We may want to think about targeting our prevention and harm-reduction activities,” said Carnide.

She also pointed out that workplace injuries often result in pain and “functional interference.”

“That can make it more likely that a worker will use opioids to try and alleviate those symptoms, and in some cases that pain and functional interference can last for months, or years, after injury,” she said.

Mental health concerns

Poor mental health can also result from an injury, and the potential challenges of returning to or staying at work can also make it more likely for a worker to use opioids, said Carnide.

“Thinking about things like pressure to return after an injury, a lack of appropriate workplace accommodations, Insufficient sick leave and job precarity, as well as interruptions in employment — all of which can exacerbate poor mental health and again make it more likely that a worker will be using opioids,” she said.

Concerns about disclosure

Carnide also put a spotlight on the fact that many people may not feel comfortable disclosing issues because of stigma, fear of reprisal or other consequences.

“Workers may not be forthcoming about either their pain or their substance use due to concerns about stigma and the consequences they may face at work if they do disclose that information,” she said. “This can potentially exacerbate issues that the worker may be facing.”

Data visualization tool

Their work not only sheds light on the occupational dimensions of the opioid crisis but also challenges workplaces to reconsider health and safety protocols, especially in industries identified as high-risk.

The data visualization tool released alongside their research provides an accessible means for stakeholders across Ontario to engage with and act on these findings.

As the session concluded, the call to action was clear. Carnide and Sritharan’s research offers a critical foundation for developing targeted, occupation-specific interventions to curb opioid misuse — a pressing public health issue that intersects deeply with workplace safety and health.