The Hidden Side of the Opioid Epidemic: Occupational Exposure to Opioids
Opioid drugs are a significant problem in the United States, not only for those with substance abuse issues, but also for the many individuals who encounter opioids in the course of their typical work duties.
Opioids are extremely potent, and the risk of coming into contact with these substances is dire—incidental exposure to even a small amount of synthetic opioids can be lethal. For this reason, people at risk of workplace exposure must always protect themselves with appropriate personal protective equipment (PPE) and practice proper safety measures. This article discusses opioid PPE and safety measures in detail, and highlights the industries and jobs that are most at risk.
Current Opioid Statistics
The use and misuse of opioid drugs in the United States has increased exponentially in recent years, culminating in what the Centers for Disease Control and Prevention (CDC) and other public health organizations classify as an "epidemic." For the first time ever, someone in the United States is now more likely to die from an accidental opioid overdose than from a car crash.
According to data published in BMJ, the rate of accidental opioid deaths per 100,000 people increased significantly from 2.2 to 13.21 between the years 2000 and 2017. The CDC recently reported that between 2018 and 2019, opioid-involved death rates increased by 6%, with synthetic opioid-involved death rates increasing by as much as 15%. Overall, over 90,000 people in America lost their lives to opioids in 2020, the largest single-year percentage increase ever recorded since the opioid epidemic began in the 1990s.
The rates of accidental occupational exposure to opioids are also increasing. According to the National Institute of Environmental Health Services, U.S. law enforcement alone saw an increase in fentanyl exposure encounters from fewer than 2,000 in 2010 to nearly 14,000 in 2015.
As more of the public struggles with opioid addiction, we can expect to see more and more of our American workforce facing accidental exposure—so protecting these individuals is critical.
Types of Opioids
Opioids are a class of drugs that work in the brain to relieve pain, among other effects. The most common types of opioids include:
- Prescription opioids, including oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and methadone
- The illicit opioid heroin (which kills an estimated 40 people per day in the United States)
- Synthetic opioids, including carfentanil, sufentanil, remifentanil, alfentanil, and fentanyl, which are significantly more powerful than heroin and prescription opioids (just 2-3 milligrams of fentanyl—equivalent to 5 to 7 grains of salt—can be deadly)
Fentanyl can be prescribed by a medical doctor to treat severe forms of pain, but it is becoming increasingly prevalent as an illicit and illegally produced street drug, as well. It is frequently mixed with other drugs, often unbeknownst to people using these illicit substances. For this reason, fentanyl and other synthetic opioids are thought to be key drivers of the alarmingly increased rate of opioid overdoses and deaths.
The Clinical Use of Opioids
According to the CDC, opioids can be prescribed to treat moderate-to-severe pain experienced after surgery or acute injury, or in certain chronic health conditions like cancer.
Due to the increased risk of addiction, abuse, tolerance, overdose, and unpleasant side effects—including increased pain sensitivity, constipation, nausea and vomiting, sleepiness, confusion, depression, decreased testosterone, and itching or sweating—these powerful drugs should only be used if alternative pain control therapies are not effective.
Industries and Professions That Work with Opioids
A variety of worker populations across a broad range of industries and professions face potential exposure to opioid drugs in the United States. These include:
- EMS/first responders
- Police/law enforcement
- Firefighter/fire services
- Health care (e.g., emergency room staff)
- Research clinics
- Inpatient drug rehabilitation facilities and organizations
- Homeless shelter personnel
- Environmental services
- Public employees (e.g., Department of Transportation (DOT), highway maintenance crews, parks and recreation staff, environmental conservationists, corrections and parole officers)
Methods and Risks of Accidental Opioid Exposure in the Professional Environment
Unintentional exposure to opioid drugs in the professional environment can come in the form of ingestion, inhalation, accidental needle sticks, or absorption via contact with skin, eyes, or mucous membranes. This can occur during a range of job tasks and duties, including:
- Clean-up/removal of drugs and drug paraphernalia from public locations and/or crime scenes
- Direct patient care
- Search and seizure, investigation, frisking and arresting, transportation
- Laboratory handling and evaluation
Opioid Protective Clothing: Recommended PPE
Proper opioid PPE is essential for protecting not only the workers themselves but the people around them, as well. When used appropriately, opioid protective clothing and gear in the workplace can prevent worker exposure and reduce the chances that a worker will inadvertently introduce opioid substances into their homes and communities via contaminated shoes, clothing, vehicles, skin, hair, etc.
To this end, recommended PPE for workers who may encounter opioids include:
- Disposable nitrile gloves
- Respiratory protection (e.g., N95 respirators) and eye protection (e.g., safety goggles) if powdered illicit drugs are suspected
- Coveralls and gowns (e.g., in the laboratory setting or crime scene clean-up setting)
Additional Prevention or Mitigation Strategies for Safety in the Workplace
In addition to ensuring workers with potential exposure have proper opioid protective clothing, additional protocols and workplace standards should be enacted to maximize personnel safety and minimize the risk of exposure. These strategies include the following:
Proper Use of Opioid PPE
Workers should know how to don and doff their PPE, recognize and prevent any damage, and store and/or transport it appropriately in order to reduce the risk of cross-contamination.
If employees use disposable opioid and fentanyl safety clothing, they should be thoroughly trained on the correct methods of disposal to further reduce the risk of contamination or accidental exposure.
Anyone who may come in contact with opioids in the course of their typical job duties should be educated about the signs and symptoms of potential exposure and overdose—such as stupor, cold and clammy skin, pinpoint pupils that can become dilated later on, and bluish or purplish skin and nails—since earlier treatment to accidental exposure can improve outcomes.
Workers should also be trained to recognize what opioid drugs look like and what to do if they suspect they or someone else has been exposed.
Additional Safety Protocols
Additional safety protocols for opioid exposure in the workplace may be specific to the industry or occupational setting, but can include standards such as:
- Always having post-exposure treatments on hand whenever workplace exposure is possible—this primarily includes the availability of naloxone (Narcan®), a highly effective drug that can reverse the effects of an opioid overdose
- Providing ongoing worker training exercises, including when and how to administer naloxone
- Maintaining standard safe operating procedures (e.g., establishing scene safety, proper hand hygiene, never smoking, drinking, nor eating near potential areas of exposure, etc.)
- Training on proper donning and doffing (removal) of contaminated protective clothing or PPE such as a how-to chart or in-person practice
- Training on the proper disposal, transport, or handling of contaminated items or the substance(s)
Opioids are powerful and potentially addictive drugs that can cause extreme illness or be lethal in small doses. Today, more and more people working within certain industries face accidental exposure to opioids within the course of their typical work duties. Protecting the workforce within these industries—which ranges from laboratory to health care to law enforcement—is of utmost importance for individuals, organizations, and the community at large.
If you are an employer or company looking for cost-effective solutions to protect your workforce from accidental opioid exposure, contact International Enviroguard today or call toll free 1-800-345-5972 to speak with one of our opioid PPE specialists.