By Chris Johnston, MD, Chief Medical Officer, Pinnacle Treatment Centers
If you’ve paid attention to the news over the past several years, you know all about the opioid epidemic in the U.S.
You may even know some of the details about what caused it, and what actions local, state, and federal policy makers and officials have taken to stop the dramatic increase in opioid addiction and opioid-related overdose we’ve seen over the past 10 years.
You may have also heard or read two more pieces of news:
- For three consecutive years – from 2016 through 2018 – life expectancy in the U.S. has decreased.
- Since 1999, the suicide rate in the U.S. has increased by 33%. More people die by suicide each year in the U.S. than in motor vehicle accidents.
It’s not difficult to make a logical connection between these developments – the opioid crisis, an increase in suicide rates, and a decrease in life expectancy. If you did make that connection, you’re not alone. One of the nation’s top scientists, Centers for Disease Control (CDC) Director Dr. Robert Redfield, released this statement in late 2018:
“The latest CDC data shows that the U.S. life expectancy has declined over the past few years. Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide…these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable.”
In my work in addiction medicine, it’s my responsibility to pay attention to statements like this and facts like those above when they’re published. They have a direct impact on the work I do, and enable me to better serve my patients, their families, and my community.
That’s why a study published early this summer caught my eye. It suggests another factor may be at play here, and it’s one that needs our attention: workplace injury.
The Connection Between Workplace Injury, Substance Use, and Suicide
Before I go any further, I’d like to point out something in the CDC statement: we’re losing our family members, friends, and loved ones to causes of death that are preventable. That’s not something we, as a society, should gloss over. Nor should we let it pass by as just one more troubling news item among many.
Why?
If deaths are preventable, we should work to prevent them: it’s that simple.
That’s why this study – Suicide and Drug-related Mortality Following Occupational Injury – has my attention. It makes data-driven, evidence-based conclusions that may help us address one of the root causes of both opioid misuse and suicide, and therefore, may help us understand and reverse the decline in life expectancy we’ve seen recently.
In short, it can help us prevent deaths that are preventable.
Let’s look at the report.
After analyzing data on more than 100,000 workers injured on the job between 1994-2000, and cross-referencing those numbers with information from the Social Security Administration and the National Death Index, here’s what researchers found:
- Women who lost more than a week of work time due to workplace injury were 92% more likely to die from suicide than women with no time loss due to workplace injury.
- Women who lost more than a week of work time due to a workplace injury were 193% more likely to die from drug-related causes than women with no time loss due to workplace injury.
- Men who lost more than a week of work time due to a workplace injury were 72% more likely to die from suicide than men with no time loss due to workplace injury.
- Men who lost more than a week of work time due to a workplace injury were 29% more likely to die from drug-related causes than men with no time loss due to workplace injury.
In addition, statistical analysis of the data showed that both men and women who lost more than a week of work time to workplace injury were 20% more likely to die of any cause.
Those numbers should be surprising to most people. They’re surprising to me, but they’re also instructive.
The Human Side of Scientific Data
They’re instructive because they enable me, as an addictionologist, to identify a specific group of people – within the subgroup of people I work with every day – who are at increased risk of suicide and death from drug-related causes. When I combine the information in the new report with previous studies indicating a relationship between workplace injury and depression and a relationship between workplace injury and opioid use disorder, a picture crystallizes in my mind, and I see what appears to be a clear path from workplace injury to at least three negative outcomes:
- Opioid use disorder
- Depression
- Suicide
We can create a number of tragic scenarios based on this information, but I’ll offer two.
Scenario A:
John J. Worker has a severe workplace injury and receives an opioid prescription to manage his pain. The pain from the injuries last longer than anyone expects, and John develops an opioid use disorder. The disorder then results in unemployment, escalating drug use, a transition to illicit opioid use, and accidental overdose.
Scenario B:
Jane J. Worker has a severe workplace injury, which causes her to miss work, and eventually leads to disability. Jane, who has worked all her life, has trouble handling all the down time. She develops a major depressive disorder. But like many people, Jane thinks she should be able to handle a case of the blues herself, so she doesn’t seek treatment. Jane’s untreated depression escalates, and she attempts suicide.
Now – before you get angry with me for concocting depressing scenarios with sad endings, please reread them: neither an overdose nor an attempted suicide automatically result in death. These are tragic scenarios, that’s true.
But thanks to the new data, people like me – i.e. doctors working in addiction or psychiatrists working with mood disorders – have new tools to support people like John and Jane.
How We Can Help
For example, if John comes to my office after surviving an overdose, seeking treatment for his opioid use disorder, my new tool is an additional line of inquiry to pursue during our initial interview: I’ll ask him if he’s experienced a workplace injury.
If he says yes, it helps explain his journey from fully employed worker to opioid overdose survivor, and I can tailor his course of treatment to his specific circumstances: injury leading to opioid use disorder leading to illicit drug use resulting in accidental overdose.
And if Jane seeks support for her depression after her suicide attempt, then the psychiatrist she sees has a new line of inquiry to pursue in their initial interview, thanks to this new data: the psychiatrist can connect the dots from the suicide attempt all the way back to the workplace injury. This can help Jane understand herself, her disorder, and help her manage her symptoms and live a full life, despite the disability caused by her injury.
There’s something more important in this data, though. Both scenarios above involve post hoc damage control. As an addiction medicine physician, I can use this information to help my patients – and that’s a good thing. It’s possible for doctors in family medicine, primary care providers, or specialists to use this information prophylactically, in order to prevent the potential negative consequences of workplace injury – and that’s a better thing.
My life’s work is helping people like John and Jane bounce back, reclaim their lives, and move forward with hope for the future. I encourage my colleagues at all levels of care – from physician assistants in urgent care facility staff to general practitioners to orthopedic surgeons – to use this new information and these new tools.
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