Drug overdoses and suicides have been rising since 2000 and are major contributors to a recent decline in US life expectancy. The opioid crisis is largely to blame, with a record 47,600 overdose deaths in 2017.[1] Suicide rates in 2016 have increased 30% from 1999.[2] Case and Deaton have called these “deaths of despair.”[3]

In the study, “Suicide and drug‐related mortality following occupational injury,” published in the American Journal of Industrial Medicine, researchers found that workplace injury significantly raises a person’s risk of suicide or overdose death. Earlier studies have shown that injured workers have elevated rates opioid use and depression. In fact, depression is among the most well-documented health consequences of workplace injury.[4] [5] [6] However, no studies have measured increased deaths related to opioid use and depression among injured workers.

Injured workers often receive powerful prescription pain medication, including opioids. In one study, 42% of workers with back injuries were prescribed opioids within a year after injury.[7] Approximately 16% of those prescribed opioids continued taking them for four quarters, with doses increasing substantially over time.

The present NIOSH-supported study linked New Mexico workers’ compensation data for 100,806 workers injured in 1994 through 2000 with Social Security Administration earnings and mortality data through 2013 and National Death Index cause of death data. Among women, lost‐time injuries were associated with a near tripling in the risk of drug‐related deaths and a 92% increase in the risk of deaths from suicide. For men, a lost‐time injury was associated with a 72% increased risk of suicide and a 29% increase in the risk of drug‐related death, although the increase in drug‐related death was not statistically significant. Risks were elevated for alcohol‐related deaths and lost-time injuries for both men and women but were not statistically significant. The only other statistically significant association between lost‐time injuries and elevated death rates was for circulatory system diseases among men.

The data presented in this paper could underestimate the problem, as there are limitations in classifying multidrug use on death certificates. In addition, misclassification of drug‐related deaths and suicides can occur when cause of death coding does not incorporate findings from medical examiners and coroners.[8] The study authors did not have information on pre-injury opioid use or depression, which could potentially affect the results. Still, the authors conclude that hazardous working conditions are one aspect of the structural causes of high mortality rates from drugs and suicide.

We are beginning to see a link between work injury, opioids, addiction, and suicide. As the nation works to address the opioid crisis, improved working conditions, improved pain treatment, better treatment of substance use disorders, and treatment of post-injury depression may substantially reduce deaths following workplace injuries.

Has your workplace taken action or increased communication about opioid addiction or suicide? If so, please click here to visit the blog post on the NIOSH website and leave a comment in the comment section below the post.

References

[1] CDC [2018a]. Drug overdose deaths. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. https://www.cdc.gov/drugoverdose/data/statedeaths.html

[2] Hedegaard H, Curtin S, Warner M. Suicide rates in the United States continue to increase. NCHS Data Brief. 2018;309:1‐8.

[3] Case A, Deaton A. Mortality and morbidity in the 21st century. Brookings Pap Econ Act. 2017;2017:397‐476.

[4] Asfaw A, Souza K. Incidence and cost of depression after occupational injury. J Occup Environ Med. 2012;54(9):1086‐1091.

[5] Kim J. Depression as a psychosocial consequence of occupational injury in the US working population: findings from the medical expenditure panel survey. BMC Public Health. 2013;13(1):303.

[6] Dersh J, Mayer T, Theodore BR, Polatin P, Gatchel RJ. Do psychiatric disorders first appear preinjury or postinjury in chronic disabling occupational spinal disorders? Spine. 2007;32(9):1045‐1051.

[7] Franklin GM, Rahman EA, Turner JA, Daniell WE, Fulton‐Kehoe D. Opioid use for chronic low back pain: a prospective, population‐based study among injured workers in Washington state, 2002‐2005. Clin J Pain. 2009;25(9):743‐751.

[8] Rockett IR, Hobbs G, De Leo D, et al. Suicide and unintentional poisoning mortality trends in the United States, 1987‐2006: two unrelated phenomena? BMC Public Health. 2010;10(1):705.