Opioids at Work: Raising Awareness and Understanding - MOSH

What is an Opioid?

An opioid is a type of drug used to reduce pain. These include prescription opioids, which are prescribed for moderate to severe pain, as well as illegal opioids. Both types carry significant risks and side effects. Misusing prescribed opioids is considered illegal. This misuse involves using the medication in ways other than prescribed, such as crushing tablets, snorting the medicine, taking incorrect doses, or sharing prescriptions with others. Prescribed opioids include Hydrocodone, Oxycodone, Codeine, Morphine, etc. Illegal opioids include Heroin, Fentanyl, and other synthetic opioids made or sold by unauthorized parties.

What is Fentanyl?

Morphine and codeine are natural opioids sourced from the poppy plant, while pharmaceutical fentanyl is a synthetic opioid created in a laboratory. Fentanyl is prescribed for managing severe pain, often related to surgery, cancer, or end-of-life care. It is a highly potent opioid, 50 to 100 times stronger than morphine.
Pharmaceutical fentanyl can be misused and is often diverted to illegal drug markets. The current overdose crisis is fueled by illegally made fentanyl, which is mixed into other drugs like heroin and cocaine, making them extremely dangerous and potentially deadly.

Opioid Use Disorder

The American Medical Association, the American Society of Addiction Medicine, and most medical associations, including the CDC, classify substance use disorder as a disease, similar to diabetes, cancer, and heart disease. Opioid use disorder (OUD) is a subset of substance use disorder. It often accompanies mental health issues, which can go undiagnosed and complicate health care decisions. New data reveals that over 9.4 million U.S. adults struggle with opioid use disorder. Increased outreach and education about the benefits of treatment and anti-opioid medications are essential.

Medications for Opioid Use Disorder (MOUD), used alongside behavioral therapy, help manage withdrawal symptoms and cravings without merely substituting one drug for another. These medications support recovery by stabilizing individuals to reintegrate into work and family life. Research indicates that MOUDs do not impair cognitive or physical functioning when used at the right dosage. However, some employers in safety-sensitive roles may prohibit their use.

Overdose Response Program

Maryland Department of Health authorizes government agencies and community-based organizations as Overdose Response Programs (ORPs), allowing them to provide overdose prevention education and dispense naloxone to the community.
Naloxone is a medicine that rapidly reverses an opioid overdose. It is important to receive training on how and when to use naloxone.

Opioids and Work

The opioid crisis has significantly affected workers and workplaces nationwide. Those in high-risk jobs, with greater injury potential, are more prone to using opioids or other substances for pain management, leading to increased risks of overdose and death. Workers in emergency response, law enforcement, healthcare, and environmental services are also at risk of exposure to fentanyl and other opioids when treating overdose victims or decontaminating areas contaminated with these drugs.

According to the National Occupational Mortality Surveillance (NOMS) system the opioid-related death rates from 2007-2012 in 21 states were particularly elevated in the following industries:

• Construction and Extraction (e.g., drilling, mining)
• Food preparation and serving
• Health care (practitioners and technical)
• Health Care Support
• Personal care and service

These jobs mentioned above are physically demanding and have high injury rates. A 2020 study found that industries with elevated injury rates also tend to have higher opioid overdose rates. This correlation points to a link between the physical demands and injuries of these jobs, and an increased risk of developing opioid use disorder. Without paid sick leave, workers might use opioids to keep working through their pain.
About 63% of individuals who misuse prescription pain relievers are employed, and while 75% of employers say opioid use affects their workplace, only 17% feel well-prepared to handle it.

Overdose can cause severe respiratory depression, coma, and death. Fentanyl, which is 50-100 times more potent than heroin, is often mixed with other drugs, leading to accidental overdoses. Addressing opioid issues in the community requires tackling both illicit and prescription drugs, as they are widespread. Without paid sick leave, workers might use opioids to keep working through their pain.

Workplace Injuries and Prescription Drug Abuse

In 2018, the U.S. Bureau of Labor Statistics reported 272,780 musculoskeletal disorders (MSDs) from private employers, averaging 11 lost workdays per case. These occupational injuries are often linked to high rates of opioid prescriptions for pain management.
The industries with the highest MSD rates were transportation and warehousing, healthcare and social assistance, construction, manufacturing, and agriculture, forestry, fishing, and hunting.

Avoiding injuries and stress at work can help reduce the opioid crisis.

Employers, workers, and unions should work harder to prevent job injuries, particularly those that lead to pain treatment. Since pain can be both physical and emotional, it's important to also reduce work-related stress to help prevent opioid misuse and addiction.

Workplace Initiatives: What Actions Can be Taken?

Many workplaces lack adequate support for substance abuse and mental health issues, frequently employing punitive measures such as zero-tolerance policies that may discourage employees from seeking help. These methods ignore that opioid use disorder is a chronic condition. Stigma and bias further inhibit workers from pursuing assistance. Rather than dismissing employees with substance use disorders, employers should implement supportive approaches that encourage treatment and recovery while preserving employment. Work provides structure, purpose, and financial security, which are crucial for overall well-being.

Opioid Hazard Awareness:

https://www.uml.edu/research/cph-new/education-training/opioid-hazard-awareness/

Additional Resources:

Maryland’s Office of Overdose Response
Naloxone Save Lives

Opioids & Substance Use: Workplace Prevention & Response

Opioids: Information for Employees

Prescription Drug Misuse -Myths Vs Facts  - PDF

Addiction

Drug Fact Sheets - English
Hojas Informativas de Drogas - Spanish

Drug Fact Cards - English
Tarjetas de la Realidad de las Drogas - Spanish

Drugs, Brains, and Behavior: The Science of Addiction(NIDA) - PDF

Videos:

Opioids in the Construction Industry - Part 1
Opioids in the Construction Industry - Part 2
Opioids in Construction - Part 3

Opioids and the Workplace Training and Education
The Opioid Epidemic and the Workplace
The Opioid Crisis and Workplace Injury