Opioids in the Workplace

Opioids are a group of drugs that includes products such as morphine, heroin, methadone, fentanyl and oxycodone. This group of drugs is often prescribed to manage pain. Opioids can cause euphoria (feeling of being high), which increases the potential for the drugs to be used improperly.

Opioids include three categories of pain-relieving drugs:

• Natural opioids (also called opiates) which are derived from the opium poppy, such as morphine and codeine
• Semi-synthetic opioids, such as the prescription drugs hydrocodone and oxycodone and the illegal drug heroin
• Synthetic opioids, such as the prescription drugs methadone, tramadol, and fentanyl

Fentanyl is 50 to 100 times more powerful than morphine. Other drugs from the same group, such as carfentanil, can be 10,000 times more powerful than morphine (for those who have not built a tolerance to the drug).

As stated by the Government of Canada (2021), opioids are intended to treat pain. Doctors may also sometimes prescribe them for other conditions, such as moderate to severe diarrhea, or moderate to severe cough.

If you have been prescribed an opioid medicine, it should:

• only be taken as prescribed
• never be used by someone for whom it was not prescribed
• never be taken with alcohol or other medications (except as prescribed)

Prescription opioid medications are available in various forms, such as:

• Syrups
• Tablets
• Capsules
• Nasal sprays
• Skin patches
• Suppositories
• Liquids for injection

However, in the case of illegal drugs it is not always possible to determine if other components have been added. Fentanyl, for example, has no taste or smell. However, only a few grains (similar to grains of salt) can cause severe harm, including death. In some cases, fentanyl is found in counterfeit pills that are made to look like prescription opioids, and it can be mixed with other drugs such as heroin or cocaine.

Opioid use can be a concern in the workplace for several reasons:

• Use as a result of workplace injuries
  • Opioids are prescribed to manage pain, including injuries that have resulted from the workplace. Workplaces that have, for example, slip and trip hazards or heavy work can be associated with opioid use.
  • Opioid use and misuse tend to be higher in workplaces that have lower paid sick leave and lower job security, suggesting that individuals may feel they need to return to work quickly after an injury and use these substances to control pain. Lack of paid sick leave and lower job security may also make workers reluctant to take time off to get appropriate treatment.
• Effects of taking opioids, including safety when working (e.g., driving, operating equipment, etc.)
  • Short-term side effects include drowsiness, nausea, vomiting, euphoria (feeling high), difficulty breathing, headaches, dizziness, and confusion. These effects may cause impairment and the individual may not be able to do their job safely.
  • Long-term side effects include increased tolerance, substance use disorder or dependence, liver damage, and worsening pain.
• Problematic opioid use or substance use disorder
  • People who use prescription drugs may misuse them, which may lead to the development of a dependence.  It has been noted that prescription misuse for opioids may lead to illegal drug use, including the use of heroin or other street drugs.
  • As a person develops an addiction, they begin to crave the drug and continue to use it regardless of the harmful effects. This need becomes the focus of their feelings, thoughts, and activities.  As a result, the individual may not be focused on their work or may be unable to do the job safely.
• Dealing with a poisoning
  • You may encounter a customer, client, member of the general public, or co-worker who has been poisoned by the product.
• Safety of the first responder
  • A first responder may encounter the product when performing first aid measures or routine law enforcement duties.

Workplaces can:

• Prevent injuries.
  • Injuries such as those caused by lifting (manual materials handling), working in awkward positions, repetitive manual operations, pushing and pulling, or slips, trips and falls can lead to the need for pain medication.
• Provide a mechanism for employees to report when they feel impaired, or if they suspect impairment in others.
• Include the use of prescription medication in polices about impairment in the workplace.
  • This policy can include that it is not permissible for employees to offer their prescribed medications to others, even if the other person has a similar prescription.
• Encourage employees to discuss options for other options for pain control with their health care providers.
• Provide education and training, including the following topics.
  • Safe working and lifting techniques, including work-related musculoskeletal disorders.
  • Back injury prevention.
  • Awareness of the impact of using opioids, even when prescribed. 
  • Recognition of impairment in self and others.
  • Safety during first response activities (e.g., first aid or law-enforcement).
• Provide appropriate training to first aid responders and provide naloxone as part of your first aid response program. 
• Offer "return to work" programs to allow an employee time to recuperate before returning to full duties.
• Offer health care benefits that include access to services such as physical or massage therapy as methods to treat the injury or pain where appropriate.
• Offer employee assistance programs (EAP) or access to similar programs to assist employees dealing with drug use issues, dependence, addiction, etc.

The Government of Canada suggests:

Keep your medication safe to help prevent problematic use by others by:

• never sharing your medication with anyone else (this is illegal and may also cause serious harm or death to the other person);
• keeping track of the amount of pills remaining in a package;
• storing opioids in a safe and secure place, out of the reach of children and teenagers.

Unused portions of opioid medicine should always be:

• kept out of sight and reach of children and pets;
• stored in a safe place to prevent theft, problematic use, or accidental exposure;
• returned to a pharmacy for safe disposal if it is no longer needed or expired. Safe disposal prevents any possibility of illegal use and protects the environment from contamination.