In which occupations are formerly injured Ontario workers most at-risk of opioid-related harms?

The ongoing opioid crisis in North America has disproportionately affected individuals of working age. As a result, researchers have started to investigate the role of workplace factors as a possible contributor to opioid use and its related harms. This study set out to examine whether Ontario workers in certain occupations are at higher risks of opioid-related harms.

For this study, researchers examined how the risk of opioid-related harms varied by occupation and industry in a large group of Ontario workers who previously had an accepted workers’ compensation claim involving time loss from work. The harms identified in this study included poisonings (often referred to as overdoses) and mental and behavioural disorders (for example, dependence syndrome or withdrawal state).

The group of former workers’ compensation claimants for this study was drawn from the Occupational Disease Surveillance System (ODSS). The ODSS contains data on 1.7 million Ontario workers who had an accepted lost-time workers’ compensation claim for a work-related injury or illness between 1983 and 2019. These workers’ compensation data, which came from the Workplace Safety and Insurance Board (WSIB), included information about claimants’ occupation and industry at the time of their work-related injury or illness. This information was linked to health records to identify hospitalizations and emergency department visits for opioid-related harms that occurred from 2006 to 2020.

Workers in this dataset were categorized into broad occupational groups and specific occupations. For each occupational group, the researchers calculated the risk of experiencing each opioid-related harm compared to all other formerly injured workers in the ODSS.

The broad occupational groups associated with the highest risks of opioid-related poisonings and/or mental and behavioural disorders are shown in Table 1.

Within some broad occupational groups, differences in risk were seen across specific occupations, shown in Table 2. 

Increased risks of one or both types of opioid harms were also seen among specific occupations, including: 

• horticultural nursery workers; 
• service station attendants; 
• guards and watchmen; 
• nursing aides and orderlies; 
• tellers and cashiers; 
• occupations in lodging; 
• chefs and cooks; 
• waiters, hostesses and stewards; 
• occupations in personal service and other service (namely janitors and cleaners); and
• occupations in metal, wood and other fabricating.

This study shows that distinct occupational patterns exist among formerly injured workers experiencing opioid-related harms. The identification of occupational groups with higher risks of harms can be used to strategically target prevention activities as part of the compensation and recovery process, to support workers’ compensation claimants at risk for future opioid-related harms.

Highly physical jobs were found to be among those associated with the highest risk of harms, which could be explained by workers with highly physical job demands experiencing higher rates of work-related injury and pain. As a result, these workers may use or be prescribed opioids at a higher rate to manage pain. A companion study also examined how opioid-related harms among workers in the ODSS compared to harms in the general Ontario population, finding that formerly injured workers were indeed at an elevated risk of opioid-related harms.

Other workplace factors that are common to these higher risk occupations may also increase the likelihood of problematic opioid use. These factors could include pressure to stay at work due to job insecurity, non-standard employment arrangements, limited sick leave, lack of work accommodations, and norms about working through injury and not seeking help. Other potential risk factors might include long work hours, work that is far away from home and family, job-related time demands, and social isolation. Unfortunately, limitations in the ODSS data do not allow these factors to be investigated in the current study.

This study is one of the few to examine occupational patterns in opioid-related harms in a large group of Canadian workers, albeit only those with a previous workers’ compensation claim. A strength of the ODSS is that occupation and industry information, captured as part of the claim reporting process, can be used to understand risk of opioid-related harms into the future. Also, while most research has focused on opioid-related deaths, this research expands the scope to include emergency department visits and hospitalizations, as well as to include mental and behavioural disorders as an opioid-related harm.

A limitation of this study is that the ODSS only includes formerly injured workers, which may mean those in occupations with a high risk of work injury may be over-represented in this analysis and results for specific occupations or occupational groups may not be representative of the risk to all people employed in these groups. Injured workers, however, may also be more likely to use opioids to manage pain due to injuries, so an in-depth look at these occupations is helpful to prepare targeted prevention and harm reduction strategies. Additionally, since workers’ occupations were recorded at the time they filed the claim that got them into the ODSS, the study may not accurately capture the occupation information at the time of harm, for example, if workers later changed jobs.