Opioid overdose deaths more likely among Mass. residents injured at work, new DPH report says

BOSTON — Working-age Massachusetts residents who died between 2011 and 2020 were 35 percent more likely to have died of an opioid-related overdose if they had previously been injured at work, according to a new report released Thursday by the state Department of Public Health.

The report, for the first time, links the aftermath of work-related injuries to opioid-related overdose deaths.

Using the Public Health Data Warehouse, DPH compiled information about individuals’ employment and work-related injury status from their workers’ compensation claims and linked it with data from their death certificates. By linking these data sets, DPH found that of the 4,304 working-age (16-64 years) Massachusetts residents who died and had at least one workplace injury claim, 741 (17.2 percent) died from an opioid-related overdose between 2011 and 2020. Previous analyses primarily relied on death certificate data, which have limited work-related information.

“A lot of the injuries we saw were things like sprains and strains,” said Emily Sparer-Fine, ScD, MS, director of the Occupational Health Surveillance Program at DPH. “And that was a result of very physically demanding work.”

The data also show that injured workers who died from an opioid-related overdose were more likely to be male, between 25-44 years old, Hispanic, US-born, and have jobs in construction and extraction (e.g., quarrying and mining), as well as in food preparation and serving, compared with those who died of causes unrelated to substance use. Sprains and strains, particularly of the back, were the most common injury types among those who suffered fatal opioid-related overdoses – a significant finding that allows DPH to, for the first time, assess the correlation between acute and chronic pain from occupational injuries and opioid use and death.

“Occupational injuries can take both a physical and mental toll, and those who suffer injuries at work may be discouraged from seeking help because of stigmatization and fear of losing their jobs. Avoiding or delaying care can lead to a preventable overdose death,” Secretary of Health and Human Services Kate Walsh said in a statement. “In order for us to properly address the overdose crisis, we must eliminate the stigma that accompanies substance use disorder in all sectors of society, including the workplace. We are prioritizing investments in community support, prevention, and treatment programs and reducing any barriers to treatment, all of which can help prevent overdose deaths.”

“Overdose deaths are preventable, and we must continue to focus relentlessly on finding ways to prevent opioid addiction from stealing more lives,” Department of Public Health Commissioner Robbie Goldstein said in a statement. “The data are clear: Individuals who suffer work-related injuries are at a heightened risk of substance use disorders – and overdose deaths. By recognizing and acting upon this association, we can target interventions that can save lives and protect the well-being of workers, especially those in physically demanding occupations who are disproportionately affected by the opioid epidemic.”

Workers in industries and occupations that require very physically demanding work and who have much higher rates of overall workplace injury than other workers continue to be disproportionately affected by the opioid epidemic, according to the report, which was created by DPH’s Occupational Health Surveillance Program.

The majority (28.2 percent) of the 741 Massachusetts workers who were previously injured at work and who died of an opioid-related overdose between 2011 and 2020 worked in construction and extraction occupations, according to the data. This is followed by 11.2 percent who worked in transportation and material-moving, and 6.8 percent who worked in food preparation and serving-related occupations.

Sparer-Fine said these industries sometimes offer no or very limited sick days -- so no work, no pay.

“And so there’s often a push to work through the pain,” she said.

That can cause more pain and worsen an initially manageable injury -- leading to higher need for pain medications. And then there is the stress of not being able to work.

Addiction Specialist Joji Suzuki, MD sees the data from this study as an opportunity to nip addiction in the bud -- by targeting industries in which opioid overdose deaths are highest.

“We should be making sure these individuals have access to health care,” he said. “And access to addiction treatment.”

Suzuki said it’s unclear whether the higher numbers of overdose deaths in certain industries is a result of those industries attracting workers predisposed to an addictive disorder.

Work-related factors, such as lower rates of paid sick leave, low wages, and higher job insecurity (e.g., seasonal work, independent contractors, and temporary help), exacerbate the pressure on workers to work while ill or injured, and not seek crucial medical or substance use treatment for fear of losing income.

While the data indicate there were lower numbers of deaths among residents of color who were injured at work compared with white non-Hispanics, who made up the majority of the state’s workforce in 2011-2020, Hispanic workers in Massachusetts suffer the highest rate of death from workplace injury. Nationwide, both Hispanic and Black non-Hispanic workers disproportionately work in the most dangerous jobs that can lead to injury.

This report may not represent the full picture of injured workers who died from an opioid-related overdose in Massachusetts. The data do not include workers who were injured on the job but who did not file a workers’ compensation claim, officials said. This cohort may include immigrant and undocumented workers who may be less likely to file a workers’ compensation claim or may experience barriers to filing one.

The state’s fiscal year 2024 budget earmarks more than $700 million in substance addiction prevention and treatment programs to address the state’s overdose crisis, including an expanded 24/7 overdose prevention helpline available by calling 800-972-0590 and at safe-spot.me.

“By establishing the strong link between work-related injuries and fatal opioid-related overdoses among Massachusetts workers, this report also underscores the role that employers, unions, employee assistance programs, and other entities play in preventing fatal opioid-related overdose,” the DPH said in its statement. “This includes injury prevention, as well as creating a work environment that fosters communication to help remove the stigma surrounding substance use and asking for help, providing harm reduction strategies like naloxone training, and intentionally centering voices from Hispanic, Black non-Hispanic, and other communities of color in program-planning and outreach strategies.”

One thing that is clear, he said, is that some patients need opioid medications to treat their pain -- along with other modalities -- and they do not become hooked.

That may partly be because they have fewer opportunities to get hooked. .

“We’ve come a long way,” Suzuki said. “The total number of prescribed opioids has come down dramatically.”

Key findings from the report:

  • From 2011 to 2020, there were 117,417 total deaths among working age (16-64 years) Massachusetts residents.
  • Among these, 4,304 – about 4 percent – had at least one workers’ compensation claim with the Massachusetts Department of Industrial Accidents for a work injury occurring from 2011 to 2020.
  • Of this cohort, 741 died from opioid-related overdoses; 191 from other substance use/poisonings (including alcohol); and 3,372 from other causes.
  • 87 percent of injured workers who died from opioid-related overdoses in 2011-2020 were male; 13 percent female.
  • Working age residents who reported a prior work-related injury were 35 percent more likely to have died of an opioid-related overdose than all working-age adults (17 percent vs. 13 percent).
  • 84 percent of injured workers who died from opioid-related overdoses in 2011-2020 were white non-Hispanic; 10 percent were Hispanic; 4 percent were Black non-Hispanic.
  • 94 percent of injured workers who died from opioid-related overdoses in 2011-2020 were born in the United States.
  • Percent of injured workers who died from opioid-related overdoses in 2011-2020 by occupation:
  • 28 percent – construction, extraction
  • 11 percent – transportation, material moving
  • 7 percent – food preparation, serving related
  • 7 percent – production
  • 6 percent – building and grounds cleaning, maintenance
  • Leading work-related injuries among workers who died from opioid-related overdoses in 2011-2020: strain/sprain (including to the back), crushing or contusion, laceration or puncture, and fracture.

This is a developing story. Check back for updates as more information becomes available.

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