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Worker Led Solutions to the Opioid Crisis

When Ironworker Shawn Nehiley was prescribed the opioid OxyContin to treat pain for a work injury, the drug’s pull to addiction hit him like “a tornado that you feel you can’tget out of.” Nehiley is a business agent with Ironworkers Local 7 and a MassCOSH board member.

National COSH is tackling the opioid epidemic at one of its most important roots, one that is often overlooked: work-related pain, injury, and stress. We are seeking to reduce the need for addictive pain medication by promoting worker-led solutions across the country.   Through participatory research, we engage workers and other stakeholders in documenting key factors that lead workers to using pain medications.  

Through peer-to-peer education, we build skills and knowledge among at-risk and impacted workers to lead efforts for change.   Through findings generated from research and trainings, we advocate for tangible concrete solutions, including changes to public policies and workplace practices – to end this deadly crisis.

An Alarming Epidemic

Epidemic rates of opioid addiction and overdose are causing catastrophic harm — and physical and emotional pain from workplace exposures are significant risk factors.   Studies in Utah found that 57% of people who died from opioid-related overdose had previously suffered a work-related injury.   In Massachusetts, workers employed in industries with high injury rates have the highest rates of overdose deaths. Construction workers in the state had six times the number of opioid fatalities than other industries, while labor-intensive industries like health care and food preparation led all workplaces for opioid overdose rates among women workers. A new report from Massachusetts documented that 25% of 220 workplace fatalities in 2016-2017 were overdoses that occurred at work.

It is estimated that more than a million people are out of the workforce due to this crisis. The national response has focused on providing training funds through states and counties to workers in recovery and to provide financial incentives for employers to hire them.     But to stop the growth of overuse and overdose of addictive pain medications, we must focus attention on prevention of workplace injury, illness, and stress.   Additionally, punitive workplace drug policies and stigma deter workers who need access to treatment from coming forward or being able to   return to and sustain their employment.

COSH collaborative solution

Our initiative includes participatory research to engage workers and impacted community members in developing solutions through research that can then be put into action. This comprehensive peer-to-peer initiative, focused on the workplace, aims to identify root causes and lower risks for individuals who are vulnerable to misuse of addictive substances.

We also foster collaborative efforts to reform punitive workplace drug policies so that workers who need access to treatment are not afraid to step forward. Part of these reforms are to develop return-to-work solutions so that workers who go into treatment and recovery   can sustain their employment.   Building on a MassCOSH pilot initiative, we are engaging impacted and at-risk workers as leaders in developing and leading the initiative, and partnering with public health practitioners, unions, community groups and academic institutions in enacting concrete solutions.


Educational Materials

CPWR – Construction worker resources

NIEHS Clearinghouse for Worker Safety & Health TrainingOpioids & Substance Use: Workplace Prevention and Response page

Institute for Work & Health – 5 Things We Think You Should Know About Return to Work

Connecticut Department of Public Health – The Opioid Crisis and Connecticut’s Workforce – Updating Your Approach to Employees Suffering from Addiction Can Preserve Your Greatest Resource

State of New HampshireRecovery Friendly Workplace

Resources for Emergency and Health Care Responders

DEA – Briefing guide for first responders

NIOSH – Preventing Occupational Exposure to Emergency Responders Guide and Video

NIOSH – Preventing Occupational Exposure to Healthcare Personnel in Hospital and Clinic Settings

Labor Union Information

Laborer’s Health & Safety Fund of North America – What to Ask if You Are Prescribed an Opioid

International Association of Fire Fighters – Responding To The Opioid Crisis Toolkit

International Union of Operating Engineers Substance Abuse Resource Center (Also has four testimonial videos)

International Union of Painters & Allied Trades, Helping Hand (Suicide prevention, substance abuse, and more)

Chemical/Physical Information

NIOSH – Response card for fentanyl

BC Centre for Disease Control – Overdose prevention recognition and response training manual

National Safety Council – Stop Every Day Killers, (Stories, videos, and mor)

Research Articles/Reports

Massachusetts Department of Public Health, Occupational Health Surveillance Program (2018); Opioid-related Overdose Deaths in Massachusetts by Industry and Occupation, 2011-2015.

Harduar Morano L, Steege AL, Luckhaupt SE. Occupational Patterns in Unintentional and Undetermined Drug-Involved and Opioid-Involved Overdose Deaths — United States, 2007–2012. MMWR Morb Mortal Wkly Rep 2018;67:925–930.

Franklin GM, Mai J, Wickizer T, Turner JA, Fulton-Kehoe D, Grant L. Opioid dosing trends and mortality in Washington State workers’ compensation, 1996-2002. Am J Ind Med 48:91-99, 2005.

National Safety Council – Workers and Opioids: a snapshot

UMass Lowell, Center for the Promotion of Health in the New England Workplace; Opioids and Work: A Formative Research Assessment to Inform Educational Outreach, November, 2018.

National Institutes of Health (NIH), U.S. National Library of Medicine (NLM). Opioid Addiction and Treatment Health Information Resources.

NIOSH – Studies, guidelines, research and data


IUOE Video – The Road Home; 2019

IUPAT Video – Helping Hands

NIOSH – Illicit Drugs, Including Fentanyl: Preventing Occupational Exposure to Emergency Responders

National Institute on Drug Abuse (NIDA/NIH) – Dr. Phil Skolnick discusses intranasal naloxone

DEA – Fentanyl Roll Call Video

WBAL-TV 11 Baltimore – First responders concerned about fentanyl exposure


Macy B. 2018. Dopesick: Dealers, Doctors, and the Drug Company that Addicted America. Little, Brown and Company.
This book focuses on the Appalachian region, which includesformer coal miners and industrial workers who are impacted by despair, hopelessness, and lack of opportunity and have been hard hit by the crisis. Dopesick and Dreamland tell many case studies of the impact of the crisis on families, the afflicted, law enforcement, and communities.

Quinones S. 2016. Dreamland: The True Tale of America’s Opiate Epidemic. Bloomsbury Press.
“There are not enough stars in the rating system to accurately explain how important this book is… Every word is important and every story heartbreaking. Every fact astonishing but true. I thank Sam for keeping this conversation going and for bringing research and heart to the table.”

Temple J. 2015. American Pain: How a Young Felon and His Ring of Doctors Unleashed America’s Deadliest Drug Epidemic. Lyons Press.