Risk of opioid-related harms by occupation within a large cohort of formerly injured workers in Ontario, Canada: findings from the Occupational Disease Surveillance System
Objective Working-age individuals have been disproportionately affected by the opioid crisis, prompting interest in the potential role of occupation as a contributor. This study aimed to estimate the risk of opioid-related poisonings and mental and behavioural disorders by occupation and industry within a cohort of 1.7 million formerly injured workers. Methods Workers were identified in the Occupational Disease Surveillance System, a system linking workers' compensation data (1983-2019) to emergency department and hospitalisation records (2006-2020) in Ontario, Canada. Cox proportional hazards models were used to estimate HRs and 95% CIs for hospital encounters for opioid-related poisonings and mental and behavioural disorders by occupation and industry compared with all other workers, adjusted for age, sex and birth year. Results In total, 13 702 opioid-related poisoning (p) events (n=10 064 workers) and 19 629 opioid-related mental and behavioural (mb) disorder events (n=11 755 workers) were observed. Elevated risks were identified among workers in forestry and logging (HRp=1.45, 95% CI 1.09 to 1.94; HRmb=1.70, 95% CI 1.34 to 2.16); processing (minerals, metals, clay, chemical) (HRp=1.27, 95% CI 1.14 to 1.42; HRmb=1.26, 95% CI 1.14 to 1.39); processing (food, wood, textile) (HRp=1.12, 95% CI 1.01 to 1.24; HRmb=1.19, 95% CI 1.09 to 1.31); machining (HRp=1.13, 95% CI 1.04 to 1.21; HRmb=1.17, 95% CI 1.09 to 1.25); construction trades (HRp=1.57, 95% CI 1.48 to 1.67; HRmb=1.59, 95% CI 1.51 to 1.68); materials handling (HRp=1.32, 95% CI 1.22 to 1.43; HRmb=1.22, 95% CI 1.13 to 1.31); mining and quarrying (HRmb=1.68, 95% CI 1.34 to 2.11); and transport equipment operating occupations (HRp=1.18, 95% CI 1.09 to 1.27). Elevated risks were observed among select workers in service, sales, clerical and health. Findings by industry were similar. Conclusions Results provide additional evidence that opioid-related harms cluster among certain occupational groups. Findings can be used to strategically target prevention and harm reduction activities in the workplace. Data availability statement Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available.