Weekend Reads | Your Risk of Drug Overdose Might Have to Do With Where You Work

by Kevin Schofield

This weekend's read is a recent report from the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics looking at connections between drug overdose deaths and specific occupations and industries. Drug overdoses have skyrocketed over the past 10 years, largely because of the proliferation of synthetic opioids, such as fentanyl — synthetic opioids now account for about two-thirds of all overdoses in the United States — and also stimulants, such as methamphetamine.

A lot of our attention is focused on highly visible overdoses within the chronically homeless community that happen on the streets of our cities and towns, but the drug overdose epidemic goes far beyond that: Substance abuse and overdoses reach into every part of our society. For some, the path begins with prescription opioid medications to treat chronic pain, often from on-the-job injuries. For others, it might begin with prescription stimulants, including Adderall, to treat ADHD or depression. Over time, people can develop dependency or resistance to these drugs, requiring more frequent or larger doses. And if someone loses their health care coverage, they might turn to the street to acquire them, further raising the chances of an accidental overdose.

The CDC's study looks at overdose deaths only in the working population in the United States; there are, of course, substantial issues with substance abuse and overdoses in the unemployed population (especially the homeless unemployed), but the intent of the study was to identify whether particular industries or occupations have a higher risk of drug overdoses.

And that is exactly what they found. In 2020, across the entire U.S. workforce, there were about 42 overdose deaths per 100,000 workers. But among workers in the construction and extraction industries, it was 163 overdose deaths per 100,000 — four times higher. In the food industry, it was almost triple the average: 117. Generally speaking, service industry and more active jobs had elevated levels of overdose deaths, and "desk jobs" in education, computers, legal, finance, science, and management professions had much lower than average rates.

The CDC suggests there are two "intersecting pathways" that lead to this result. The first is physical pain due to on-the-job injuries or the accumulated physical trauma of specific kinds of work (like repetitive motion injuries). Job insecurity, lack of health care coverage, and financial pressures are all associated with a return to work too early that might exacerbate painful injuries and lead to abuse of prescription and non-prescription pain medications.

The second pathway is "psychosocial stressors" at work, such as working long hours, toxic or abusive work environments, and job insecurity. They are associated with increased mental health issues that might worsen substance use disorders — and increase the chance of an overdose.

These results align with other studies; for example, the CDC notes that food service and hospitality workers have the highest rates of reported illegal drug use and substance abuse disorders.

The report provides interesting data on which specific jobs have the highest risk. Topping the list are fishers, sailors, and roofers. A wide variety of construction trades have disproportionately high rates, including drywall installers, painters, masons, carpenters, and iron and steel workers. But at the same time, waiters and waitresses are also in the "top 10" list.

This is not a perfect study; or, perhaps more accurately, it's not a complete study. To try to put the overdose rates in context, it leans heavily on a "proportionate" measure of overdoses: what percentage of all deaths in a particular occupation or industry were due to overdoses, and how that compares with the workforce as a whole and other occupations and industries. But that conflates several other issues; for example, some jobs are inherently more dangerous and have more fatal on-the-job accidents; likewise, some occupations tend to have older workers who are more likely to have other serious health issues. Both of these will skew the relative proportions of deaths due to overdoses.

The report also only begins to dig into the racial and ethnic disparities in the numbers. It notes that Hispanic construction workers are less likely to have health care insurance and are also less likely to use prescription pain medications. Hispanics are overrepresented in the deaths of those working in the construction and extraction industries, but they are not overrepresented among overdose deaths in those industries. The data also shows that overdose death victims are overwhelmingly white (70%) and male (75%).

The value of having a study like this is twofold. First, it gives us strong indications as to what leads to drug overdoses: Industries and occupations with high serious injury rates also tend to have high drug overdose rates. Second, it suggests where we should concentrate our efforts if we want to prevent drug overdoses; interventions in the occupations and industries with the highest overdose rates are likely to have the largest impact.

Drug Overdose Mortality by Usual Occupation and Industry: 46 U.S. States and New York City, 2020

Featured image by Martin Novak/Shutterstock.com.