Understanding the connection between opioids, pain, and the workplace

Understanding the connection between opioids, pain, and the workplace.

The opioid epidemic is a serious problem in the US, with opioid overdose deaths higher than ever. The impact is everywhere, including the workplace.

Stigma around addiction can create a negative assumption: that people who struggle with a substance use disorder are not part of the workforce. Not only is that assumption wrong, but workplaces have a powerful opportunity to serve as a venue for public health efforts. In fact, 70% of people experiencing substance use are working.

What’s more, the workplace can directly contribute to the problem, especially in industries where employees are at higher risk of injury.


of workplace injuries go unreported

BOTTOM LINE: today’s employers have both an opportunity and an obligation to be part of the solution, through policies and practices that support opioid use disorder (OUD) recovery and create a safe, healthy workplace.

What are some factors that lead to OUD?

  • Injuries from unsafe working conditions
  • Pain from work-related tasks
  • Work-related stressors like high demand and inconsistent schedules
  • Pre-existing mental and physical health conditions

External factors:

  • Traumatic events (e.g. death, divorce, abuse, family history of addiction, etc.)
  • Mental health disorders
  • Using other substances or engaging in other risky behavior
  • Financial problems
  • Underlying physical health problems
  • Housing instability

Overview of Opioids

Opioids are a class of drugs found naturally in the poppy plant or made synthetically in a lab. They may provide pain relief to some people under certain circumstances. Opioids include prescribed drugs such as oxycodone (Oxycontin), hydrocodone (Vicodin), fentanyl, and many others – as well as illegal drugs such as heroin.

Opioids attach to pain receptors in the brain and other organs, blocking pain messages from other parts of the body. Besides providing temporary relief from pain, they activate powerful reward centers in the brain. But they can also slow down breathing. Overdose happens when opioids cause someone to stop breathing altogether, and it can be deadly.

Fentanyl is a synthetic opioid that’s highly potent – about 100 times the strength of morphine. It may occasionally be prescribed in small doses under close medical supervision, but is commonly found in non-prescribed “street” drugs. Fentanyl is now the leading cause of overdose and overdose deaths in Massachusetts and many other states.

People quickly develop opioid “tolerance,” meaning they need more of the drug to achieve the same effect. When people become addicted, their tolerance may increase even more. Not only do they need more of the opioid to relieve pain – they need it simply to avoid withdrawal. Stopping use of opioids is very difficult and can be extremely uncomfortable, because of extreme withdrawal effects like anxiety, restlessness, insomnia, bone and muscle aches, vomiting, diarrhea, and others. The safest way to stop taking opioids is to taper down under the direction of a healthcare provider, or to seek medication-assisted treatment (MAT).

The Massachusetts Substance Use Helpline can help identify treatment options for those who want to stop using opioids.

Call 800.327.5050 or visit HelplineMA.org to learn more.

Opioids may occasionally be effective as short-term treatment for pain – usually, less than three days. But it can put people at risk for longer-term addiction or OUD. To help patients avoid becoming addicted, medical providers must closely monitor opioid treatment for pain, following the state and CDC guidelines.

People who have been prescribed opioids may want to speak to their doctor about their dose, schedule, and alternative options for managing pain.

Opioid use and opioid prevention in the workplace:

Workplace-based risk factors for opioid addiction and death

Research shows that industries with the highest risk for pain and injury also have the highest rates of addiction and overdose deaths. These industries can include construction, forestry, fisheries, and certain areas of the healthcare and service industries. In addition to high injury rates, these fields also tend to have less available medical leave and lower job security.

Overview of policies and practices to prevent and manage injury and pain

Injury prevention

Workplace injuries can lead to pain and addiction, if opioids are used to treat the pain. By creating and enforcing a culture of safety and health, employers can reduce workplace injuries and work-related pain. This way, they lower the risk that opioids will be used in the first place.

Accurate reporting

Sometimes, workers are afraid to report workplace pain and discomfort. As many as 70% of workplace injuries are never tracked.3 That means the relationship between workplace demands, pain, and opioid use goes underreported – and is too often ignored. By encouraging accurate reporting and tracking, employers can start to understand the scope of the problem.

Effective communication

Employers can also help prevent OUD by creating an emotionally safe work environment. They can encourage employees to speak up about injuries, pain, and substance use without fear of stigma or retaliation. They can also educate employees and managers about the true risks of opioid use in the workplace. See this guide to workers’ compensation reporting for more insight.

Opioid overdose prevention and response

No employer wants to think about a worker overdosing on the job. But by actively planning for overdose prevention, response, and postvention, employers can save lives. And the simple act of being prepared sends a message of compassion and support to workers who may be experiencing OUD.

Components of an opioid overdose action plan

A comprehensive overdose action plan includes three main components:

Overdose prevention

Education around workplace safety, opioid use, and overdose risks

Overdose response

Protocols that include overdose kits with Narcan and training on use

Overdose postvention

Follow-up support for employees, plus continuing education and workplace messaging

While supportive messaging that reduces stigma is especially important after an overdose event, it’s critical to all workplace prevention efforts. When employers show basic support, workers may be more likely to seek help if they’re experiencing pain, injury, or opioid or other substance use disorder.

Overdose Prevention, Response, and Postvention Resource

HRiA’s “Overdose Prevention, Response, & Postvention: Promising Policies and Practices for Organizations” includes recommendations for reducing fatal opioid overdoses, and provides guidance on developing, implementing, and updating organizational policies and procedures.

Overdose Prevention and Response Trainings

Here is a list of all the available trainings for you and your workplace to better understand opioids and how you can prevent and help workers with OUD.