More than 47,000 people die annually from opioid overdoses in the U.S. This is equivalent to roughly 130 deaths per day, close to five per hour, or one every 12 minutes. In just under 20 years, opioid overdose death rates have increased almost 500%. Why?
One reason is workplace musculoskeletal disorders (MSDs); they’ve recently been identified as a key factor in opioid-related overdose deaths. Data from the Utah Department of Health, the Office of Medical Examiners, and the Labor Commission on all Utah residents showed that 57% of those who died from opioid-related deaths had at least one prior workplace MSD. The highest rates of opioid-related overdose deaths occur in industries with higher injury rates and physically demanding working conditions, including regular forceful exertions.
Occupational categories with the highest rates of opioid-related overdose deaths include construction, agriculture, material moving occupations, maintenance/repair, transportation, production, food preparation, waste management, and healthcare. In all of these categories, work requires forceful exertions. There is a clear correlation between jobs with the highest injury and illness rates and opioid-related overdose death rates.
MSDs, or soft tissue injuries, are painful disorders of the muscles, nerves, tendons, ligaments, joints, cartilage, or spinal discs. They affect all body areas, but the most common areas are the upper extremities (shoulders, elbows and hands) and the lower back. MSDs are the result of exposure to biomechanical risk factors such as forceful exertions, awkward postures, sustained exertions, high frequencies and vibration, among others. These injuries occur most often at companies lacking an ergonomics process.
In simple terms, ergonomics is defined as designing the workplace to match people’s capabilities. The goal of ergonomics is to optimize human performance. When it’s done correctly, there are two primary positive outcomes: improved employee well-being and enhanced business performance.
When ergonomics is not practiced at all, or not done correctly, there are social and economic consequences; the most recognizable social consequence is workplace MSDs. These are the second greatest cause of disability globally, having increased 45% since 1999, according to the 2010 Global Burden of Disease Study. Globally, low back pain is the leading cause of “years lived with disability” (YLD) from 1990 through 2015. YLD is a metric of prevalence of disease. Low back pain represents the sixth greatest global burden of disease based on “disability-adjusted life-years” (DALYs), just behind HIV/AIDS (fifth) and just ahead of Malaria (seventh). DALYs is a metric of population health. In the U.S., these metrics are similar.
In the U.S., upper extremity MSDs and low back pain are the most prominent occupational injuries and illnesses. MSDs account for almost one-third (31%) of all occupational injuries and illnesses in the U.S. and incur a median of nine days absence from work. In Canada and Europe, they account for half (50%) and two-fifths (39%) of all occupational injuries and illnesses, respectively. Undeniably, MSDs contribute a large proportion of all compensable work-related diseases in the U.S. and globally.
The economic consequences of MSDs are staggering. In 2004, the direct costs of treatment for MSDs in the U.S. were estimated at $510 billion, equivalent to 4.6% of the gross domestic product (GDP). Indirect costs were estimated to add $339 billion more, for a total cost for MSDs of $849 billion, or 7.7% of the GDP. According to the OSHA Safety Pays Program, the typical direct cost of an upper extremity MSD ranges between $28,866 and $33,258. The typical direct cost of a low back pain disorder ranges between $22,548 and $76,430.
Evidence suggests that the leading cause of occupational injuries in the U.S. is forceful exertions or over-exertions. Over-exertions include manual lifting, lowering, pushing, pulling, carrying and throwing. They account for almost one-quarter (23%) of all occupational injuries and cost roughly $13.79 billion annually. Forceful exertions leading to MSDs are also considered a growing global problem.
There are a variety of treatment options for workers recovering from a workplace MSD, including participating in physical rehabilitation, undergoing invasive surgical procedures, using over-the-counter medications, and for those workers with chronic pain or pain associated with surgery, taking powerful pain medication such as opioids. Starting in 2000, when the Veterans Health Administration, the Joint Commission and other organizations adopted the idea that “pain is the fifth vital sign,” opioid prescription rates for the treatment of pain increased significantly. For example, between 2002 and 2005, 42% of injured workers in the state of Washington with acute low back pain were prescribed opioids as a treatment method.
Further research has shown that prescribing rates and the doses of opioids are higher in workers’ compensation insurance claims compared to private insurance claims. In addition, data shows that injured workers are prescribed higher doses of opioids to allow them to continue to work or to return to work sooner.
Despite these statistics, there is some good news: the overall opioid prescribing rate in the U.S. peaked and leveled off from 2010 to 2012 and has been declining since 2012, according to the CDC. But it is still very concerning. In 2017, 58 opioid prescriptions were still written for every 100 people. Also, the amount of opioids prescribed per person (measured in morphine milligram equivalents, or MME) is still approximately three times higher than it was 20 years ago. MME is a way to calculate the total amount of opioids, accounting for differences in opioid drug type and strength.
The use and abuse of opioids—including prescription pain relievers, heroin and synthetic opioids—is still a serious public health crisis with devastating societal and financial consequences. Drug overdoses and suicides have been rising annually since 2000; this is associated with a recent decline in life expectancy in the U.S.
So, it’s worth mentioning again:
• More than 47,000 people die annually from opioid overdoses in the U.S
• This is equivalent to roughly 130 deaths per day, close to five per hour, or one every 12 minutes.
• In just under 20 years, opioid overdose death rates have increased almost 500%.
The CDC estimates that the financial burden of opioid use and abuse is about $78.5 billion a year. This is equivalent to nearly $215 million per day, $9 million per hour, or $150,000 per minute in the U.S. These costs include healthcare, lost productivity, addiction treatment and criminal justice involvement.
It is undeniable that workplace MSDs contribute to the opioid crisis, and poor workplace ergonomics is a recognized contributor to MSDs. It is critical that workplace interventions be implemented to address the workplace hazards that lead to injuries for which opioids are prescribed. This includes deploying a comprehensive and systematic process for identifying, analyzing and controlling workplace risk factors that lead to workplace MSDs.