Opioids: Addiction, Escalation and Overdose

November 15, 2016

Sometimes, workplace injuries require serious medical interventions, including the use of powerful prescription medications. Opioids, a class of prescription medications that are all derived from the same plant as heroin, are a particularly powerful—and particularly dangerous—class of prescription painkiller, and one that’s become especially prominent as a treatment for injured workers. In fact, according to the National Institute of Drug Abuse, the number of opioid prescriptions written has nearly tripled in the past three decades, and the trend shows no signs of slowing down. In certain circumstances, opioids are a powerful tool that can ease a patient’s pain or aid in a speedy recovery from a traumatic injury. However, the risks associated with opioids—addiction, escalation to heroin or other drugs, and overdose—mean that employers need to remain vigilant about this pervasive, and potentially lethal, risk.

Dependence and Addiction

Patients who are prescribed opioids are often susceptible to dependence and addiction. Because the prolonged use of opioids results in a higher tolerance, the body’s endogenous opioids (which are opioids, like endorphins, that occur naturally in the body) become insufficient to stave off the physical symptoms of withdrawal. Doctors are aware of and even expect many patients to develop a physical dependence if prescribed opioids for a prolonged period of time. Fortunately, doctors can account for this and create interventions that allow patients to break their dependence, usually by gradually lowering the dosage.

Unfortunately, physical dependence is often a precursor to addiction. Addiction occurs when a patient develops uncontrollable cravings for a drug and engages in risky or self-destructive behavior in order to acquire it. It’s worth noting that not all people who develop an addiction have a physical dependency on the drug, just as not all those who have a dependence on the drug will necessarily become addicted.

More than 16,000 Americans die every year from a prescription pain medication overdose.

Heroin Use

One especially disturbing trend has been the rapid increase of both heroin use and heroin overdose. These increases coincide with the increased prevalence of opioid use and overdose in the United States. Though it is a disturbing trend, the correlation isn’t altogether surprising. Prescription opioids are chemically very similar to heroin, which is a naturally occurring drug derived from the opium poppy. Two factors—the chemical similarity between heroin and prescription opioids and the increased availability of more potent forms of heroin flooding the country in recent years—have created an environment in which people see and use opioids and heroin interchangeably. When opioid users transition to heroin, either as a supplement to or as a cheap replacement for opioids, they then assume all of the risks associated with unregulated, illegal drugs. Unknown levels of purity can make it hard to ascertain the amount of heroin the body can tolerate, and additives used to “cut” the drug might themselves be lethal.


Overdose is an especially complicated risk when it comes to opioids. Most overdoses are usually the result of a patient taking a combination of drugs that can depress the central nervous system and depress breathing, resulting in suffocation. Case law has been varied, depending on both the state and circumstances of overdose. In some cases though, employers may be required to pay workers’ compensation benefits to the survivors of workers who have overdosed on opioids prescribed to treat a job-related injury. But, even in cases where other drugs aren’t in play, patients can and still do overdose. One of the side effects of opioid use is impaired judgment and confusion. It’s not uncommon for a patient to take a dose and find him- or herself taking an additional dose, having forgotten about the earlier dose.

3 Ways to Curb Opioid Abuse

Fortunately, there are measures that employers can take to decrease the abuse of opioids among employees. Some are preventive, while others are designed to identify and combat opioid abuse in employees. Taken together, they represent a robust, comprehensive strategy for keeping employees safe and free from substance abuse.

  1. Educate Workers: The best way to combat drug use is to stop it before it starts, and the best way to prevent opioid abuse is through education. The good news is that a number of surveys show that patients are becoming more invested in their health care treatment plans and are looking for more information. Use that as an opportunity to educate your workers on the dangers of opioid use.
  2. Speak with Health Care Providers:If your company partners with a clinic, make sure to talk to doctors about the danger of overprescribing opioids. Sometimes, when dealing with severe acute pain or chronic pain for which other interventions have failed, opioids might be an appropriate treatment. Often, though, doctors may prescribe opioids to patients who might do just as well, or better, with other, less dangerous pain relievers. Make sure the doctors that you work with are aware of all treatment options and are diligent about preventing opioid abuse.
  3. Gather Thorough Patient Histories:Certain risk factors—like depression, high blood pressure or obesity—radically increase the likelihood of dangerous side effects from opioid use. Gathering patient histories can alert doctors to these risk factors and allow them to alter treatment plans so that patients with a high risk are closely monitored for those ill effects.

Mitigate the Risks

Opioids can be a powerful tool to assist in the healing process, so eliminating them completely isn’t an option. For more information on how to mitigate the risk of opioid abuse, contact us today.