Enthusiastic participants engaged in large and small group dialogues about the state of opioid-related hazards in the workplace characterized the 2018 Worker Training Program (WTP) workshop(https://www.niehs.nih.gov/news/events/pastmtg/hazmat/2018/), held Oct. 24-25 at NIEHS.

Discussions about the U.S. opioid epidemic are frequent, but the impact of opioids on workers may be left out of the conversation. Certain occupations, such as emergency medical services, law enforcement, and environmental services, face a high risk of occupational exposure to opioids — including the extremely toxic fentanyl and carfentanil — when responding to overdoses.

But that is only part of the problem. Workers in high-injury occupations, such as construction, are often prescribed opioids as treatment for work-related injuries. The medication can quickly lead to opioid use disorders, addiction, or even death.

Opioid-related incidents were the cause of 43 percent of deaths in construction, farming, and other trades in Massachusetts.

Creating a plan of action

“This is a national public health emergency,” said Chip Hughes, program director for WTP, which funds organizations nationwide to provide occupational health and safety training to workers.

“We want to know, Is there a training approach that we can develop to deal with this crisis and prevent it from worsening?’” he said. “This workshop was organized to get input from our network of workers and trainers and to hear from the frontline workers, unions, and those who deal with this on a daily basis.”

“This is a public health crisis,” Hughes said during his welcome speech to workshop attendees. (Photo courtesy of Steve McCaw)

Starting the conversation

“Opioid usage disorder is a chronic, relapsing disorder,” said John Howard, M.D., J.D., director of the National Institute for Occupational Health and Safety (NIOSH), during his keynote address. “Lifetime treatment is necessary.”

“Even a tiny amount is a lethal dose,” Howard said of fentanyl, one of the most potent opioids being misused. (Photo courtesy of Steve McCaw)

Howard detailed the difference between the drugs and described how they work in the body.

• Opiates such as heroin, morphine, and codeine are naturally derived from the flowering opium poppy.
• Opioids, including fentanyl and carfentanil, are synthetic or partially synthetic.

Fentanyl is used to treat severe cancer pain or manage pain after surgery. It is 50 to 100 times more potent than morphine and even small amounts are lethal to humans. First responders are at risk for coming into contact with the drug and may not know when a given situation puts them at risk.

Howard shared resources NIOSH developed for first responders, including ways to tell if a person has overdosed, what to do to avoid exposure to opioids through contact, and the work NIOSH has done to respond to this crisis.

An engaged crowd listened to Howard’s keynote address at the WTP workshop on opioid-related hazards in the workplace. (Photo courtesy of Steve McCaw)

Which industries are most at risk?

A recent report from the Massachusetts Department of Health documented 4,301 workers in the state who died from opioid overdoses between 2011 and 2015. Lead author, Letitia Davis, Sc.D., said that those working in the trades, including construction and mining, fishing and farming, and material moving — all physically demanding jobs — were at the highest risk for opioid-related deaths.

Not unsurprisingly, the report uncovered high overdose rates in occupations with high injury rates. Job insecurity and lack of paid sick leave also play a role. These workers use opioids to manage pain so that they are able to work, Davis explained, often times leading to opioid use disorder or overdose.

“We have to reconceptualize what drug use stigma means in the workplace,” she said. “It means you’re going to lose your job if you don’t come to work.”

Davis is from the Occupational Health Surveillance Program in the Massachusetts Department of Public Health. (Photo courtesy of Steve McCaw)

Priority on prevention

Organizers included sessions on treatment and recovery, intervention strategies and risk awareness, education for workers, public health measures, and better opportunities for paid time off after injury. Presenters stressed the importance of mental health resiliency and eliminating the stigma associated with misuse.

“We are committed to developing a training portfolio that is much broader than what we have created in the past,” Hughes said. “By organizing this workshop, we are contributing to the national conversation. As always, with our program, primary prevention is the priority.”

(Sheena Scruggs, Ph.D., is Digital Outreach Coordinator in the NIEHS Office of Communications and Public Liaison.)