In which occupations are Ontario workers who had a work-related injury most at-risk of opioid-related harms?

In brief

In certain occupations and industries, Ontario workers who had a work-related injury or illness are at an elevated risk of experiencing opioid-related harms (poisonings and mental and behavioural disorders). Occupational groups with elevated risks of opioid harms include: forestry and logging, processing, machining, construction and materials handling.
These findings can guide targeted prevention and harm reduction strategies for workers and workplaces at higher risk of opioid-related harms.

Why was this study done?

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.

How was this study done?

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 workers examined in 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 workers in the ODSS.

What did the researchers find?

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

Table 1: Broad occupational groups associated with higher risks of opioid-related harms
Broad occupational groups	Risk of opioid-related poisonings compared to all other workers in the ODSS	Risk of opioid-related mental and behavioural disorders compared to all other workers in the ODSS
Forestry and logging	1.45 times higher	1.70 times higher
Processing (minerals, metals, clay, chemical)	1.27 times higher	1.26 times higher
Processing (food, wood, textile)	1.12 times higher	1.19 times higher
Machining	1.13 times higher	1.17 times higher
Construction	1.57 times higher	1.59 times higher
Materials handling	1.32 times higher	1.22 times higher
Transport equipment operating	1.18 times higher	--
Mining	--	1.68 times higher

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

Table 2: Specific occupations associated with higher or lower risks of opioid-related harms
Broad occupational groups	Specific occupations	Risk of opioid-related poisonings compared to all other workers in the ODSS	Risk of opioid-related mental and behavioural disorders compared to all other workers in the ODSS
Construction	Excavating, paving, and grading	Higher	Higher
	Other trades (e.g., roofers, painters, brick and stone masons)	Higher	Higher
	Electrical trades	Lower	Lower
Machining	Metal shaping and forming	Higher	Higher
Machining	Metal machining (tool and die making, machinists, machine tool setting up)	Lower	Lower
Transport equipment operating	Water transport	Higher	Higher
	Motor transport (trucking)	Higher	Higher
	Air transport	Lower	Lower

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.

What are the implications of the study?

This study shows that distinct occupational patterns in opioid-related harms exist among workers who had a work-related injury or illness. 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 workers who had a work-related injury or illness 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.

What are some strengths and weaknesses of the 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 workers who had a work-related injury or illness, 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.

Note, though, that the time between the work-related injury or illness experienced by workers in this group and their subsequent opioid-related harms ranged widely. As such, it’s not known where workers were in their recovery at the time they experienced the opioid-related harms. 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.

Acknowledgements

This study is a collaboration between the Institute for Work & Health and the Occupational Cancer Research Centre at Ontario Health.

This project has been made possible through funding from the Public Health Agency of Canada (2021-HQ-000092). The views expressed in this summary do not necessarily represent the views of PHAC. The Occupational Disease Surveillance System (ODSS) is supported by the Workplace Safety and Insurance Board (WSIB) and is jointly funded by the Ontario Ministry of Labour, Immigration, Training, and Skills Development (MLITSD) and the Ontario Ministry of Health (MOH). The ODSS has received previous funding from the Public Health Agency of Canada.

Reprinted from the Institute for Work & Health (IWH). First published October 2024.