Previously injured workers in sectors including construction, mining and forestry are more likely to end up in the emergency room or to be hospitalized due to opioid-related harm than workers in other sectors in Ontario.
That’s according to findings from Opioid-related Harms Among Ontario Workers, an ongoing research project being conducted by the Institute for Work & Health and the Occupational Cancer Research Centre.
The findings were presented by the co-leads on the study — Dr. Jeavana Sritharan, the scientist surveillance lead at OCRC, and Dr. Nancy Carnide, an associate scientist at the Institute for Work and Health — during a June 29 webinar hosted by EPID at Work, a 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 across North America.
In Canada, between January 2016 and September 2022, more than 34,000 people died from opioid use, she noted.
“Males of working age, particularly those between the ages of 30 and 49, have been disproportionately affected,” she said. “This has led to interest in understanding why we are seeing these patterns, including interest in the role of occupation.”
For their study, the researchers are consulting the Occupational Disease Surveillance System (ODSS), a large database of information collected from more than 2.37 million Ontario workers that helps identify trends in occupational disease. In particular, 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 harms consist of both opioid poisonings (overdoses, both intentional and unintentional) and mental and behavioural disorders.
The study focused on two types of results from opioid-related harms among workers between 2006 and 2020: visits to the emergency department and hospitalizations. And researchers also did two types of comparison: first they examined opioid-related harms among workers in the ODSS as compared to their counterparts in the general population, and then compared opioid-related harms between workers within the ODSS.
“What we saw overall is that workers in the ODSS had an elevated risk for all opioid-related harms when compared to the general Ontario population,” Sritharan said.
“So when looking at opioid-related harm by either data source — emergency department visit or hospitalizations — the (numbers) are elevated and statistically significant.”
Occupations that posed the highest risk — with the most workers visiting the emergency department with an opioid-related poisoning — were construction and trades, materials handling, processing, machining, forestry and logging, and transport equipment operating.
Sritharan said those results mirror findings in other U.S. studies on the topic.
For workers who were hospitalized due to an opioid-related harm, the findings were similar.
The top six occupations in that category included construction and trades, materials handling, processing, machining, service, and transport equipment operating. Service refers to those in the food and beverage industry, including chefs, cooks, bartenders, waitresses, hotel managers, and janitors and cleaners.
The results were again similar when researchers looked at workers who experienced opioid-related mental or behaviour disorders.
Of those who made a trip to the emergency department, the top occupation was again construction and trades, followed by materials handling, processing, machining, farming, and processing (food, wood, textile).
The same was true for those workers who had been hospitalized due to an opioid-related harm. Construction and trades was the top sector represented, followed by materials handling, processing, machining, mining, and other crafts and equipment operating
For the second analysis — comparing workers in the ODSS to the general population — Sritharan said many of the same or similar trends play out.
“Really, what we’re trying to show is this consistency that we’re seeing, regardless of however we slice the data, or whichever comparison group we examine,” she said.
Carnide said that, looking at the postal codes associated with each case, the researchers are able to make some connections by geography as well.
When they looked just at workers in the ODSS, they found a higher risk of opioid-related harms — both poisonings, and mental and behavioural disorders — for workers who reside in Northern Ontario.
“Consistently, we see that workers in the ODSS in Northern Ontario were at higher risk of experiencing each type of harm compared to all other workers in the ODSS,” she said.
“We also see similar findings for workers in the southwest region, and then central west, at least for the outcome of poisonings.”
Workers in eastern Ontario and Toronto were less likely to experience opioid-related harms 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 ease the pain from injury.
Alongside physical injury, a worker’s mental health may also suffer, she noted, which could make them more likely to use opioids.
They might feel pressure to return to work after the injury, experience a lack of appropriate workplace accommodations, have insufficient sick leave, or feel a level of job insecurity.
Carnide said certain occupational groups might also be at higher risk because many, like construction or transportation, tend to be male-dominated.
In those environments, workers could feel pressure to work through the pain, or substance use could simply be more accepted at their workplace.
Other factors could also contribute to their likelihood to use opioids, such as the demands of the job, how much support workers receive in the workplace, and how isolated the work is.
“Workers may not be forthcoming about either their pain or substance use due to concerns about stigma and the potential consequences they may face at work if they do disclose that information,” Carnide said.
“This is particularly true if you think about safety-sensitive occupations, and certainly this could potentially exacerbate issues that the worker is facing.”
