The widespread use of opioids in the United States has been characterized as the worst man-made epidemic in modern medical history. Among its many effects, the epidemic is a pervasive problem in occupational health services, often delivered to injured workers through the workers’ compensation system.

To take a closer look at the issues, the School of Public Health is welcoming Thomas Wickizer to speak about the problem during the NORA Symposium on May 5. Wickizer is professor and chair in the College of Public Health at Ohio State University.

We spoke with Wickizer ahead of the symposium to gain a greater sense of the opioid epidemic’s severity and causes within occupational health and the general population.

What is the nature and scope of the opioid epidemic in America?

More than 200,000 people have died since 1999 from opioid overdose. Hundreds of thousands of hospitalizations and emergency room visits related to opioid use have occurred during this period. No social or economic class has been spared from this epidemic.

The opioid problem has resulted in a significant loss of productive years of life.  At a minimum, it has resulted in over 5,000,000 years of productive life lost since 2000. Also, statistically, women suffer more chronic pain than men and are therefore more likely to be prescribed pain relievers. From 2000 to 2010, 48,000 women died of opioid overdose.

What do you see as the epidemic’s root cause?

Physicians and other providers supply too many opioids for pain relief.  Even after surgery, studies show patients are provided many more opioids than they need for pain relief. To change this, dentists, for example, should prescribe Tylenol or NSAIDS like ibuprofen for pain relief after tooth extraction instead of 14 days of opioids.

How is the epidemic playing out in the workplace related to occupational health?

A large proportion of occupational injuries are musculoskeletal in nature and related to the bones, joints, muscles, and nerves. Injured workers are often prescribed opioids to treat this pain. The problem is, opioids are linked to a longer recovery time — just a seven-day supply of opioids used shortly after injury doubles the risk of being off work and on disability at one year after injury.  In the aggregate, opioid use seems to contribute significantly to the national burden of occupational disability.   

How can we stop the epidemic and what role does public health have?

Providers need to be better educated about the risks of opioid prescription. State regulations regarding opioid prescribing and prescription monitoring need to be tightened. In general, the public needs to be better educated about the risks of opioids and alternatives for pain relief. Public health can play a key role in addressing the opioid problems through public health science and health services research. We need to develop more effective, evidence-based programs for addressing the problem of chronic pain.

Overall, the opioid epidemic needs to be moved to the center of the public health and occupational health care policy and research agendas.