PRESCRIPTION DRUG OVERDOSE PREVENTION

Overview

This NIOSH Topic Page is intended to provide useful information for workers, employers, healthcare providers, and other stakeholders interested in learning more about work-related factors involved with prescription drug overdose prevention.

Prescription drug abuse and overdoses are a major public health concern. Drug poisoning deaths involving opioid analgesics in particular have more than tripled since 1999, with more than 16,000 deaths in 2013 alone. The CDC has been focused on boosting resources for State prevention efforts in conjunction with other Federal efforts to help States expand and intensify their work to address this growing problem.

What You Need to Know

Prescription drug abuse impacts nearly all aspects of society. Workers in all industries or sectors may face unique risks as injuries sustained at work are increasingly treated with powerful prescription drugs including opioids such as fentanyl (Duragesic^®, Actiq^®), hydrocodone (Vicodin^®, Lortab^®), oxycodone (OxyContin^®, Percocet^®), and oxymorphone (Opana^®, Numorphan^®). Recent workers` compensation studies reveal that there is increasing use of prescription drugs in workers’ compensation claims and that narcotics account for 25% of drug costs in such claims.  Work-related issues associated with increased opioid use include the potential for: (a) work-related injuries to initiate prescription drug (including opioid) use and possibly subsequent misuse; and (b) increases in worker injuries associated with use of such drugs as contributing or causative factors.^1,2

CDC Resources

NIOSH Topic Pages

Center for Workers’ Compensation Studies (CWCS)
Focuses on working with partners to use workers’ compensation data to improve workplace safety and health. The CWCS teams NIOSH researchers with colleagues in the public and private sectors to explore opportunities for leveraging workers’ compensation data to reduce the incidence of work-related injuries and illnesses. In addition to its efforts to prevent injuries and illnesses, the CWCS also supports workers’ compensation programs created to minimize the risk of opioid dependence among workers and maximize the ability to return to work safely.

Topic Pages from Other CDC Centers/Institutes/Offices

Injury Prevention & Control: Prescription Drug Overdose
Provides extensive information on this topic from the National Center for Injury Prevention and Control.

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

Public Health Law Program: Prescription Drugs
Provides up to date information to help prevent drug overdose deaths and apply scientific expertise to help curb the prescription drug overdose epidemic.

The National Center for Health Statistics annual report, Health, United States, 2014
Includes a special Table on drug poisoning deaths involving opioid analgesics – see “Table 30. Death rates for drug poisoning and drug poisoning involving opioid analgesics, by sex, age, race, and Hispanic origin: United States, selected years 1999–2013”

State Efforts to Address Opioid Use in Workers' Compensation Systems

Many states have taken steps to address opioid use in their workers’ compensation systems by limiting opioid availability, educating health care providers on responsible opioid prescribing, and increasing awareness among injured workers. Examples of State opioid prescribing policies, protocols, and guidelines are listed here. Please note that inclusion on this list does not convey CDC endorsement.

• The California Department of Industrial Relations
  • Guideline for the Use of Opioids to Treat Work-related Injuries (2014)
  • The Medical Board of California: Guidelines for Prescribing Controlled Substances for Pain (2014)
• The Colorado Department of Regulatory Agencies
  • Policy for Prescribing and Dispensing Opioids
• The Connecticut Workers’ Compensation Commission
  • Medical Protocols
• The Michigan Workers’ Compensation Agency
  • Amended Workers’ Compensation Rules for Opioid Treatment
• The New Hampshire Department of Labor
  • Treatment Guidelines for Opioid Use
• The New York Workers’ Compensation Board
  • New York Non-Acute Pain Medical Treatment Guidelines (2014)
• The Ohio Bureau of Workers Compensation
  • Opioid Prescribing Guidelines
• The Oklahoma Physician Advisory Committee and Oklahoma Workers’ Compensation Court
  • Guidelines for Prescription of Opioid Medications for Acute and Chronic Pain (2007)
• The Oregon Workers’ Compensation Division
  • Opioid Use Guidelines (short-term and long-term)
• The Tennessee Department of Health
  • Tennessee Chronic Pain Guidelines
• The Utah Department of Health
  • Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain (2009)
• Washington State Agency Medical Directors' Group
  • Interagency Guideline on Prescribing Opioids for Pain (2015)
• The Wyoming Department of Workforce Services, Narcotic Monitoring and Pain Treatment Guidelines
  • http://wyomingworkforce.org/providers/guidelines/

Other Key Resources

• Several Department of Health and Human Services (DHHS) websites provide information concerning other Federal initiatives.  DHHS activities to address opioid abuse, dependence, and overdose are described at http://aspe.hhs.gov/opioid-abuse-us-and-hhs-actions-address-opioid-drug-related-overdoses-and-deaths.
  • Workers can access a searchable database of substance abuse programs through the Substance Abuse and Mental Health Service Administration (SAMHSA) website.
    • Fact Sheets on Preventing Prescription Abuse in the Workplace
    • Prescription Abuse in the Workplace Webinar
    • Responding to Prescription Drug Abuse
  • The National Institute on Drug Abuse website provides information from the National Institutes of Health.
• National Safety Council webpage - “Addressing Opioids in the Workplace” http://www.nsc.org/learn/NSC-Initiatives/Pages/prescription-painkillers-for-employers.aspx
• Professional organizations also provide information:
  • International Association of Industrial Accident Boards and Commissions (IAIABC): Reducing Inappropriate Opioid Use in Treatment of Injured Workers

References

1. Cheng M, Sauer B, Johnson E, Porucznik C, Hegmann K [2013].  Comparison of Opioid-Related Deaths by Work-Related Injury.  American Journal of Industrial Medicine 56:308–316 (2013)
2. Fulton-Kehoe D, Garg RK, Turner JA, Bauer AM, Sullivan MD, Wickizer TM, Franklin GM [2013]. Opioid Poisonings and Opioid Adverse Effects in Workers in Washington State. American Journal of Industrial Medicine 56:1452–1462.