A sprinkler-fitter falls off a ladder on a job, sustaining a shoulder injury severe enough to impact his ability to work. He is prescribed opioids for the pain. After 12 weeks, he is required to return to work, but his injury hasn’t yet healed. He uses opioids to cope with the pain while on the job, but that blunts his pain feedback and leads to a worsening of his injury—to the point that he now needs surgery. Throughout this process, the lack of support to recover from his injury, and of an exit strategy from opioid use, made safely returning to work a formidable challenge.
This was the story of Wayne Harris, an injured worker who now advocates for other injured workers. He shared his experience at a workshop on opioid harms among workers, hosted by the Occupational Cancer Research Centre (OCRC) and the Institute for Work & Health (IWH) in March 2024. The workshop was attended by over 100 occupational health specialists, government representatives, union advocates, researchers, and others who wanted to contribute to a discussion on how to mitigate opioid-related harms among workers.
We need to increase the awareness of opioid harms as a workplace health and safety issue. Having this group of stakeholders here today will help move the conversation to what can be done next to address this issue,
said Dr. Paul Demers, OCRC director and senior scientist, in his opening remarks.
To lay out the issue at hand, Drs. Nancy Carnide and Jeavana Sritharan, IWH scientist and OCRC scientist, respectively, presented results from their project looking at opioid harms among a large group of formerly injured workers in Ontario. Their work expanded upon a growing body of evidence that points to the role of work in contributing to the opioid crisis in North America. Their study revealed that rates of opioid-related harms in this group of formerly injured workers (who tended to be in more physically demanding occupations) were much higher than those in the general population, across most occupation and industry groups. Indeed, those at the highest risk of opioid harms generally worked in highly physical occupations such as construction, machining and transport equipment operation, among others. A data visualization tool they developed as part of this project allows the public to explore some of these data graphically.
With these data, we’ve been able to identify specific occupations that are associated with higher risk of opioid harms. This information can help to really target any prevention and harm reduction strategies to those high-risk groups,
said Carnide.
But what might these interventions look like? Dr. Cora Roelofs from the University of Massachusetts Lowell spoke to attendees about a possible framework for preventing work-related opioid harms. Often, harm-reduction strategies are aimed at responding to a crisis—like having naloxone kits to respond to an overdose in the workplace. Roelofs suggested that more attention should also be paid to proactively identifying upstream factors that could lead to opioid harms, eliminating hazards at the source. To Dr. Roelofs, this would look like tackling workplace injury risks—as these can result in workers being prescribed opioids for pain—as well as changing workplace attitudes about substance use. She suggested that interventions, namely training programs, should target these workplace factors.
Throughout the workshop, this need for training of workplaces, supervisors and employees on opioid harms, including educating workers about substance use and its effects on the brain, was a major, recurring focus. One presenter, Rob Trymbulak, spoke of his experience of battling a substance use disorder for much of his life. His testimony provided the day with a raw reminder of the toll this epidemic can have on people's lives; and in recounting his journey through recovery, he also provided hope for others that recovery is possible. He advocated for workplaces to normalize talking about substance use issues, so that employees can speak up about the challenges they may be facing.
In the afternoon’s panel discussion, representatives of government, business, organized labour, and occupational health and safety spoke about their experiences implementing various prevention strategies. The need for training was highlighted by Blair Allin of the International Brotherhood of Boilermakers Canada. He spoke of training as a way to reduce stigma, noting that workers often fear losing their jobs if they disclose and seek support for a substance use issue within their workplace.
Bill Guy of Fluor Driver Inc., a construction contractor, echoed this sentiment, adding that workers are often more comfortable speaking to their peers rather than their supervisors about their issues, and that peer support should be recognized and encouraged.
Many panelists and attendees also noted that addictions and mental health training should start early, with apprentices or even as part of schooling. In the workplace, it should also include training for supervisors on how to support their employees. Kathy Martin of the Infrastructure Health & Safety Association (IHSA) spoke of the need for both top-down approaches to help employers implement training programs and policies within their organizations, as well as bottom-up approaches to respond to opioid harms as they happen.
In terms of bottom-up approaches, panelists gave examples of successes in their programs to provide workplaces with naloxone kits and training to treat overdoses. Nathalie Chernoff of the Ministry of Labour, Immigration, Training and Skills Development spoke about the workplace naloxone legislation introduced in 2022 and its compliance program, which (for a limited time) provided one kit and training for two staff members for interested workplaces. She also spoke of the positive reception of the program by small businesses. Kayla Smith of the LCBO spoke of their naloxone pilot program which was embedded into the Crown corporation’s first aid program, mental health crisis procedures, and employee assistance program that included substance use support. She also spoke of the need for wraparound supports for employees who respond to an incident in-store.
Martin closed out the panel discussion with a note about the challenges in building such initiatives in industries that are already overworked. She emphasized the importance of giving the issue priority despite all the other demands they face. Many workplaces know about the issues; they just don’t have opioid poisonings on-site or see opioid impairments among their workers,
she said. Moving forward, we need to be framing the issue as a wider conversation on what workplaces can do to ensure they are not part of the problem and start becoming part of the solution—not just for opioid harms, but for worker harms in general.
As many attendees noted during the Q&A and breakout sessions, research drives action. To convince employers who are on the fence about investing time and resources into programs, panelists and attendees alike noted that it helps to have data to show workplaces the impact opioid harms are having in their industry, including data to build a business case within organizations to prioritize prevention strategies.
Other initiatives that attendees identified as most pressing fell along the theme of preventing opioid harms at the source. These initiatives include preventing workplace injury, providing training to workplaces on opioid harms, normalizing peer-to-peer conversations about substance use issues, and addressing barriers to treatment, such as stigma and negative repercussions of disclosure.
As many of these top-down approaches are longer-term solutions, involving research, advocacy and policy-development, attendees were left with a closing note that, in the meantime, smaller initiatives towards these end goals should also be considered. As Martin notes, we don’t need to do everything all at once. Even taking just a few tangible steps can start making a difference.
A full summary of this workshop is being prepared and will be linked here and on the OCRC’s website upon its completion.