Construction, mining workers most affected by opioid-related harm: study

Previously injured workers in industries such as construction, mining and forestry are more likely to end up in the emergency room or be hospitalized for opioid-related harm than workers in other Ontario industries.

That’s according to findings from Opioid-related Harms Among Ontario Workers, an ongoing research project conducted by the Institute for Work & Health and the Occupational Cancer Research Center.

The findings were presented by the study’s co-leaders – Dr. Jeavana Sritharan, the chief of scientific surveillance at OCRC, and Dr. Nancy Carnide, an associate scientist at the Institute for Work and Health — at a June 29 webinar hosted by EPID at Work, an occupational health research institute at Lakehead University in Thunder Bay.

Carnide said the research was inspired by the growing public health crisis related to opioid poisonings in North America.

In Canada, more than 34,000 people died from opioid use between January 2016 and September 2022, she noted.

“Working-age men, especially those between the ages of 30 and 49, have been disproportionately affected,” she said. “This has led to an interest in understanding why we see these patterns, including an interest in the role of occupation.”

For their study, the researchers consulted the Occupational Disease Surveillance System (ODSS), a large database of information collected from more than 2.37 million workers in Ontario that helps identify trends in occupational illness. Specifically, this study looks at data from 1.7 million of those workers, all of whom have previously been injured on the job.

Sritharan noted that opioid-related harm includes both opioid poisonings (overdoses, both intentional and accidental) and mental and behavioral disorders.

The study focused on two types of outcomes of opioid-related harm among workers between 2006 and 2020: emergency department visits and hospital admissions. And researchers also performed two types of comparisons: first, they examined opioid-related harm among workers in the ODSS compared to their counterparts in the general population, and then compared opioid-related harm among workers within the ODSS.

“What we saw overall is that workers in the ODSS had an increased risk of all opioid-related harm compared to the general Ontario population,” Sritharan said.

“So when we look at opioid-related harms from both data sources — emergency department visits or hospital admissions — the[numbers]are elevated and statistically significant.”

Occupations posing the greatest risk — with the most workers visiting the emergency department with an opioid-related poisoning — were construction and trading, materials handling, processing, machining, forestry and logging, and transportation equipment.

Sritharan said these results mirror findings in other US studies on the subject.

For workers hospitalized for an opioid-related injury, the findings were similar.

The top six occupations in that category included construction and trade, materials handling, processing, machining, service and transportation equipment. Service refers to those in the food and beverage industry, including chefs, cooks, bartenders, waitresses, hotel managers, and concierges and cleaners.

The results were again similar when researchers looked at employees who experienced opioid-related mental or behavioral disorders.

Of those who made a trip to the emergency department, the top occupation was again construction and trade, followed by materials handling, processing, machining, farming and processing (food, wood, textiles).

The same was true for the employees hospitalized for an opioid-related injury. Construction and trade was the top sector represented, followed by materials handling, processing, machining, mining and other crafts and equipment used

For the second analysis — comparing workers in the ODSS to the general population — Sritharan said many of the same or similar trends are at play.

“Really, what we’re trying to show is this consistency that we’re seeing no matter how we cut the data, or whichever comparison group we’re examining,” she said.

Carnide said that looking at the zip codes associated with each case, the investigators can also make some geographic connections.

When they looked only at workers in the ODSS, they found a higher risk of opioid-related harm — both poisonings and mental and behavioral disorders — for workers living in Northern Ontario.

“Consistently, we see that workers in the ODSS in Northern Ontario were at a higher risk of experiencing any type of harm compared to all other workers in the ODSS,” she said.

“We also see similar findings for workers in the southwestern region and then the central west, at least for the outcome of poisonings.”

Workers in eastern Ontario and Toronto were less likely to experience opioid-related harm than all other workers in the ODSS, she added.

More research is needed to further explore the relationship between work and opioid-related harm, Carnide said. But the current theory is that workers who are injured are more likely to use opioids to relieve the pain of an injury.

In addition to physical harm, an employee’s mental health can also suffer, she noted, making them more likely to use opioids.

They may feel pressure to return to work after the injury, experience a lack of appropriate workplace adjustments, have insufficient sick leave, or feel some degree of job insecurity.

Carnide said certain occupational groups may also be at greater risk because many, such as construction or transportation, tend to be male-dominated.

In those environments, employees could feel pressure to work through the pain, or substance use could simply be more accepted in their workplace.

Other factors may also contribute to their likelihood of using opioids, such as the demands of the job, how much support workers receive in the workplace, and how isolated the job is.

“Employees may not be upfront about their pain or substance use because of concerns about stigma and the potential repercussions they could face at work if they disclose that information,” Carnide said.

“This is especially true if you’re thinking about security-sensitive occupations, and this could certainly exacerbate the problems the worker faces.”