Risk of opioid-related harms by occupation within a large cohort of formerly injured workers in Ontario, Canada: findings from the Occupational Disease Surveillance System

Nancy Carnide, Jeavana Sritharan, Chaojie Song, Fateme Kooshki, Paul A Demers.

ABSTRACT
Objective Working-age individuals have been disproportionately affected by the opioid crisis, prompting interest in the potential role of occupation as a contributor. This study aimed to estimate the risk of opioid-related poisonings and mental and behavioural disorders by occupation and industry within a cohort of 1.7 million formerly injured workers.

Methods Workers were identified in the Occupational Disease Surveillance System, a system linking workers’ compensation data (1983–2019) to emergency department and hospitalisation records (2006–2020) in Ontario, Canada. Cox proportional hazards models were used to estimate HRs and 95% CIs for hospital encounters for opioid-related poisonings and mental and behavioural disorders by occupation and industry compared with all other workers, adjusted for age, sex and birth year.

Results In total, 13 702 opioid-related poisoning (p) events (n=10 064 workers) and 19 629 opioid-related mental and behavioural (mb) disorder events (n=11 755 workers) were observed. Elevated risks were identified among workers in forestry and logging (HR_p=1.45, 95% CI 1.09 to 1.94; HR_mb=1.70, 95% CI 1.34 to 2.16); processing (minerals, metals, clay, chemical) (HR_p=1.27, 95% CI 1.14 to 1.42; HR_mb=1.26, 95% CI 1.14 to 1.39); processing (food, wood, textile) (HR_p=1.12, 95% CI 1.01 to 1.24; HR_mb=1.19, 95% CI 1.09 to 1.31); machining (HR_p=1.13, 95% CI 1.04 to 1.21; HR_mb=1.17, 95% CI 1.09 to 1.25); construction trades (HR_p=1.57, 95% CI 1.48 to 1.67; HR_mb=1.59, 95% CI 1.51 to 1.68); materials handling (HR_p=1.32, 95% CI 1.22 to 1.43; HR_mb=1.22, 95% CI 1.13 to 1.31); mining and quarrying (HR_mb=1.68, 95% CI 1.34 to 2.11); and transport equipment operating occupations (HR_p=1.18, 95% CI 1.09 to 1.27). Elevated risks were observed among select workers in service, sales, clerical and health. Findings by industry were similar.

Conclusions Results provide additional evidence that opioid-related harms cluster among certain occupational groups. Findings can be used to strategically target prevention and harm reduction activities in the workplace.