Infectious Disease
Three groups of health care workers face an increased risk for death from drug overdoses
August 08, 2023
2 min read
Source/Disclosures
Disclosures:
Olfson reports being a research psychiatrist for the New York State Office of Mental Health. Please see the study for all other authors’ relevant financial disclosures.
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Key takeaways:
- Job stress and burnout may put health care workers at risk for overdose death.
- HRs for overdose deaths were higher for health care support workers, social or behavioral health workers and registered nurses.
Health care support workers, social or behavioral health workers and registered nurses were at an increased risk for death by drug overdose compared with non-health care workers, underscoring the need for interventions, data show.
Although the United States has seen an unprecedented rise in drug overdose deaths, the risks for health care workers are still unknown, Mark Olfson, MD, MPH, Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law and professor of epidemiology at Columbia University Medical Center, and colleagues wrote in Annals of Internal Medicine.
Data derived from: Olfson M, et al. Ann Intern Med. 2023;doi:10.7326/M23-0902.
“Several factors could place health care workers at increased risk for drug overdose death,” they wrote. “Those who prescribe or administer medications have ready access to opioids and other controlled prescription drugs. They also frequently have job stress and occupational burnout, which have been associated with increased risk for opioid use disorder … Many health care workers also routinely do physically strenuous tasks that can lead to musculoskeletal injuries, which can result in opioid prescriptions to manage pain and attendant risks.”
The researchers conducted a prospective cohort study to approximate health care workers’ risks for drug overdose death compared with non-health care workers. The analysis was based on data from a nationally representative cohort from the 2008 American Community Survey including 176,000 health care workers and 1,662,000 non-health care workers aged 26 years or older who were followed through 2019. The researchers determined sex- and age-standardized drug overdose deaths for six groups of health care workers:
- physicians;
- registered nurses;
- health technicians;
- health care support workers;
- social or behavioral health workers; and
- other treating or diagnosing health care workers.
An estimated 0.07% of the participants died from a drug overdose during the follow-up period, according to Olfson and colleagues. The annual standardized rates of drug overdose death among health care workers per 100,000 people varied from 2.3 (95% CI, 0-4.8) for physicians to 15.5 (95% CI, 9.8-21.2) for social or behavioral health workers.
The adjusted HRs of total drug overdose death were significantly higher for registered nurses (adjusted HR = 2.22; 95% CI, 1.57-3.13), social or behavioral health workers (aHR = 2.55; 95% CI, 1.74-3.73) and health care support workers (aHR = 1.6; 95% CI, 1.19-2.16) compared with those for non-health care workers. However, this was not the case for health technicians, other treating or diagnosing health care workers or physicians.
The researchers noted that the results were generally similar for unintentional overdose deaths and opioid-related overdose deaths.
Olfson and colleagues wrote that the findings raise concerns about “the extent to which substance use among health care workers compromises not only the health of affected clinicians but also the quality, effectiveness, and safety of the care they provide.”
“To support the behavioral health of health care workers, the National Plan for Health Workforce Well-Being emphasizes the need to involve federal, state, and local governments; health systems; health payers and insurers; private and nonprofit organizations; professional societies; academic institutions; and health care workers themselves in a range of actions,” they wrote.
Some examples of this, the researchers reported, include offering assistance to workers with addiction who fear losing their license, arranging coverage for workers to participate in behavioral health appointments and more.
“Such proactive and coordinated efforts may help lower stigma, concerns over confidentiality, fear of punitive actions, and other barriers to help seeking,” they concluded.
Perspective
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David Shumway, DO
This is a powerful and topical study. Drug abuse and overdose among health care workers is a poorly kept secret. I remember being a 4th-year medical student in the ICU and asking the charge nurse why there were no locks on the staff bathroom. The reason was a former nurse overdosed while shooting up fentanyl, and they had to rip the door off the hinges. With this study, I think the most profound conclusion involves the increased risk for overdose in support staff such as registered nurses and social workers, but not in physicians and technicians. I generally agree with the authors’ proposal that this disturbing trend is driven by a combination of emotional and physical distress endured by those at the front lines of patient care, with direct access to medications by occupational responsibility of administering them. Nurses and behavioral health workers are sadly positioned at this exact crossroads. Given the authors’ citation of the successes of intervention programs aimed at physicians being a protective factor against drug overdose in that demographic, it serves to further highlight the importance of establishing similar programs for workers across the spectrum of health care.
David Shumway, DO
Osteopathic physician, Internal medicine
Contributing writer, American Osteopathic Association’s medical publication, the DO
Disclosures: Shumway reports no relevant financial disclosures.
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