The Opioid Crisis: How Ergonomics Can Help

01/24/2020

Opioid misuse and addiction is an epidemic in the United States. But what does the opioid crisis have to do with ergonomics? National public health officials are responding to the opioid crisis by focusing on pain management and recovery services. As ergonomists, it’s our duty to identify and address the root causes of musculoskeletal disorders in the workplace. We can save lives by reducing the physical risk factors that lead to injuries in the workplace and the resulting prescription of opioid pain killers.

To better understand the impact of poor workplace design and musculoskeletal disorders on the opioid crisis I wrote an article that was published in EHS Today. Below is an excerpt of that article.

More than 47,000 people die annually from opioid overdoses in the U.S. This is equivalent to roughly 130 deaths per day, close to 5 per hour, or one every 12 minutes. In just under 20 years, opioid overdose death rates have increased almost 500%. Why is this?

One reason is workplace musculoskeletal disorders (MSDs); they’ve recently been identified as a key factor in opioid-related overdose deaths. Data from the Utah Department of Health, the Office of Medical Examiners, and the Labor Commission on all Utah residents showed that 57% of those who died from opioid-related deaths had at least one prior workplace MSD (Cheng et al., 2013).

The highest rates of opioid-related overdose deaths occur in industries with higher injury rates and physically demanding working conditions, including regular forceful exertions (CDC/NCHS, 2018). Occupational categories with the highest rates of opioid-related overdose deaths include construction, agriculture, material moving occupations, maintenance/repair, transportation, production, food preparation, waste management, and health care (Hawkins et al., 2019). In all of these categories, work requires forceful exertions. There is a clear correlation between jobs with the highest injury and illness rates and opioid-related overdose death rates.

Starting in 2000, when the Veterans Health Administration, the Joint Commission, and other organizations adopted the idea that “pain is the fifth vital sign,” opioid prescription rates for the treatment of pain increased significantly (CDC, 2017). For example, between 2002 and 2005, 42% of injured workers in the state of Washington with acute low back pain were prescribed opioids as a treatment method (Franklin et al., 2009). Further research has shown that prescribing rates and the doses of opioids are higher in workers’ compensation insurance claims compared to private insurance claims (Franklin et al., 2015; Pensa, Galusha, Cantley, 2018). In addition, data shows that injured workers are prescribed higher doses of opioids to allow them to continue to work or to return to work sooner (Dembe et al., 2011).

It is undeniable that workplace MSDs contribute to the opioid crisis, and poor workplace ergonomics is a recognized contributor to MSDs. It is critical that workplace interventions be implemented to address the workplace hazards that lead to injuries for which opioids are prescribed. This includes deploying a comprehensive and systematic process for identifying, analyzing, and controlling workplace risk factors that lead to workplace MSDs.

References:

CDC/NCHS, National Vital Statistics System, Mortality. CDC WONDER, Atlanta, GA: US Department of Health and Human Services, CDC; 2018.

Centers for Disease Control and Prevention. Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015. MMWR 2017; 66(26):697-704.

Cheng M, Sauer B, Johnson E, Porucznik C, Hegmann K. Comparison of opioid‐related deaths by work‐related injury. Am J Ind Med. 2012;56(3):308‐316.

Dembe A, Wickizer T, Sieck C, Partridge J, Balchick R. Opioid use and dosing in the workers compensation setting. a comparative review and new data from Ohio. Am J Ind Med. 2011;55(4):313‐324.

Franklin GM, Rahman EA, Turner JA, Daniell WE, Fulton-Kehoe D. Opioid use for chronic low back pain: A prospective, population-based study among injured workers in Washington state, 2002-2005. Clin J Pain. 2009 Nov-Dec;25(9):743-51.

Franklin G, Sabel J, Jones CM, et al. A comprehensive approach to address the prescription opioid epidemic in Washington state: milestones and lessons learned. Am J Public Health. 2015;105(3):463‐469.

Hawkins D, Roelofs C, Laing J, Davis L. Opioid‐related overdose deaths by industry and occupation—Massachusetts, 2011‐2015. American Journal of Industrial Medicine. Volume62, Issue 10. October 2019. Pages 815-825.

Pensa MA, Galusha DH, Cantley LF. Patterns of opioid prescribing and predictors of chronic opioid use in an industrial cohort, 2003 to 2013. J Occup Environ Med. 2018;60(5):457‐461.