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The opinions in this post are the authors' and do not necessarily reflect those of AIHA, The Synergist, or SynergistNOW.

Substance use disorder is one of the most challenging problems facing workers and employers in the United States. While alcohol accounts for the largest portion of workers with substance use disorder, opioids have played an increasing role over the last 25 years. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2020, more than 9.3 million people misused prescription opioids. Meanwhile, illegal opioids, primarily fentanyl, are responsible for increases in overdose deaths, with CDC stating that more than 110,000 Americans died from drug overdoses in 2022, the most ever reported. This trend continues today. Often, multiple substances, especially alcohol and benzodiazepines, are found in the toxicology profiles of people who died from overdoses.

A growing body of evidence connects substance use disorder to the workplace. According to CDC's Morbidity and Mortality Weekly Report, "Workers' compensation data from 26 states (2013–2015) indicated that opioids were prescribed for 52%–80% of injured workers who received pain medications." But more research is needed. A paper published in the American Journal of Public Health in 2020 argued that "work-related factors have not received adequate attention as either risk factors or opportunities for [opioid overdose death] prevention."

The answer to this growing problem is the adoption of recovery-ready workplace (RRW) policies to create safe and healthy work environments for workers who have substance use disorders or are in recovery. RRW policies use three prevention approaches:

1. Prevent the work-related conditions that can lead to new cases of addiction.
2. Support injured workers by providing access to alternative pain treatments and encouraging them to speak to healthcare providers about avoiding opioids addiction.
3. Foster a work environment where talking about substance use and mental health is encouraged, without the fear of job loss or discrimination. This includes improving access to treatment, accommodating recovery, retaining workers who enter treatment, and hiring people in recovery who have been out of work.

AIHA Volunteer Efforts

AIHA's Opioids Working Group has focused on addressing occupational exposure to fentanyl and other opioids, applying industrial hygiene techniques to protect EMS, police, and emergency room personnel from chemical exposure when responding to overdoses. The working group's efforts have expanded to address assessment and decontamination of properties and sites where harmful contaminant residues may remain.

The working group also focuses on the broader problem of misuse, addiction, and overdose in the workplace. This relates to IH because workplace injury and stress can initiate new cases of substance use disorder stemming from opioid prescription, alcohol use, lack of access to alternative pain treatments, or self-medication.

The industries with the highest rates of fatal overdose include construction, mining, warehousing, and other jobs that have higher-than-average rates of musculoskeletal disorders. Ergonomics is a core part of industrial hygiene, and IHs have the skills to evaluate work-related factors through analysis of data, including workers' compensation, health benefits, overtime, absenteeism, and OSHA records.

Benefits for Employers

In addition to reducing stigma, lowering barriers to employment, and promoting treatment for addiction, RRW programs are good for business. Data from SAMHSA indicate that most Americans with substance use disorder are employed. Employers bear the costs of substance use disorder in the form of absenteeism and increased healthcare and workers' compensation costs. In 2021, the Harvard Business Review reported that "[t]he annual costs of chronic pain due to lost productivity have been estimated to be $216 billion in the United States." Replacing workers unable to continue work due to pain also has significant costs in recruiting and training. In contrast, workers in recovery take fewer days of unscheduled leave and have a lower turnover rate.

The drug-free workplace approach, commonly mandated by employers, has been ineffective. Workers who are struggling are often afraid to come forward for fear of being fired or ostracized. Lack of access to treatment and recovery resources is an additional barrier. The drug-free workplace approach doesn't recognize that substance use disorder is a treatable chronic disease; instead, it views affected employees as discipline problems.

Supporting RRW Policies

According to the National Institute of Environmental Health Sciences (NIEHS), 31 states have launched initiatives intended to prevent substance use disorder and support recovery in employment. It is time for the IH community to contribute our skills and knowledge to this relevant area of work by supporting these initiatives and encouraging employers to adopt RRW policies.

Resources

American Journal of Public Health: "Work Environment Factors and Prevention of Opioid-Related Deaths" (August 2020).

CDC: Morbidity and Mortality Weekly Report, "Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths—United States, 2007–2012" (August 2018).

Employment and Training Administration: "Benefits of Recovery-Ready Workplace Policies."

Harvard Business Review: "When Someone on Your Team Has Chronic Pain" (July 2021).

Substance Abuse and Mental Health Services Administration: "2020 NSDUH Detailed Tables" (January 2020).