• Posted August 8, 2023

Nurses, Other Health Care Workers at High Risk of Drug Overdose

As the United States wrestles with soaring drug overdose deaths, new research finds that nurses, social and behavioral health care workers and health care support workers are at particularly high risk.

Compared with employed adults who are not health care workers, social workers and other behavioral health care workers are more than twice as likely to die of overdose, said study co-author Dr. Mark Olfson. He's professor of psychiatry, medicine and law at Columbia University Medical Center, in New York City.

Health support workers, including home health care workers, have double the odds of dying from a drug overdose, and registered nurses are about 50% more likely to do so, he added.

For the study, researchers analyzed data from 176,000 health care workers aged 26 and older between 2008 and 2019. They were compared with 1.6 million non-health care workers. Health groups studied also included physicians, other diagnosing and treating health care workers and health technicians — and they were not at higher risk of dying from a drug overdose.

About 0.07% of the health workers died of a drug overdose during the study period. About 85% of drug overdose deaths were considered opioid-related. Among the general public, 76% of overdose deaths were opioid-related.

Although the study doesn't dive into the reasons behind these fatalities, Olfson said stress may be a significant issue.

“Many times health care workers are in positions where, despite their efforts, they have very little ability to control the outcome,” Olfson said.

Some are put in the position of caring for people who are severely ill, which can take a toll over time, he noted.

“Health care workers are often subject to incredible amounts of stress,” agreed Dr. Smita Das, chair of the American Psychiatric Association's Council on Addiction Psychiatry and a professor at Stanford University School of Medicine, in California.

“Early on this has to do with rigorous training and costs of that training, and later it has to do with job responsibilities,” said Das, who was not involved in the study.

But stress is probably just one contributor to the overdose death rate.

Access to opioid medications may be among the issues for registered nurses, Olfson said. And for home health care aides, physical injuries are common, perhaps leading to taking opioids and becoming addicted.

“They have very high rates of occupational injuries, among the very highest of all the occupations in the United States,” Olfson said.

“The question becomes whether these findings provide a rationale for forcing greater oversight concerning the administration of these drugs, of controlled substances, and also their disposal for unused portions of drugs,” Olfson said.

For social and behavioral health workers, the reasons for the higher overdose rate are less obvious, but workers in jobs that provide substance use counseling may have a history of drug use, which can increase risk, Olfson said.

New initiatives are needed to reduce health care worker stress, prevent burnout, identify at-risk workers and speed access to confidential substance use evaluation and treatment, the study authors suggested.

Also, “there's a lot we need to learn about whether there are pathways there that could be identified and interrupted, to help people who are vulnerable to struggling with these problems,” Olfson said.

“The other aspect of this, of course, is we have to be concerned about the quality and the effectiveness of the safety of care that health care workers provide,” he added.

Das said the analysis sheds light on an important topic — the health of those who look out for other people's health.

“People in health care are a unique group, taking on the responsibility of caring for others, and often having to sacrifice their own well-being," she said. "As we see overdose rates continue to increase in general in the time period of this study, the unique impact on health care has not been examined before.”

While the study looks exclusively at overdose, and overdose is not always related to a substance use disorder, in many cases it may be, Das said.

In addition to possibly not having enough time to adequately address any physical or mental health needs, acknowledging a mental health or substance related issue is risky in many health professions because it can impact licensing and credentials, Das noted.

“As a result, they may seek to manage symptoms in desperate ways,” Das said.

Effective ways of treating substance use disorders include medications and cognitive behavioral therapy. With respect to overdose, easy access to naloxone and education about it is important to reverse overdose, she added.

Asked about potential solutions, Das said policies and workplaces could improve access to treatment for mental health conditions that may contribute to substance misuse.

Moreover, health care workers suffering from substance use disorders should not be discouraged from seeking treatment due to punitive policies, Das stressed.

Olfson added that stigma is a big hurdle. “There's still a great deal of stigma that surrounds coming forward and seeking out substance use treatment services. For some people with histories, there may be drug testing policies that need to be reassessed,” he said.

The study findings were published online Aug. 8 in the Annals of Internal Medicine.

More information

The U.S. Centers for Disease Control and Prevention has more on drug overdoses.

SOURCES: Mark Olfson, MD, MPH, professor of psychiatry, medicine and law and professor of epidemiology, Columbia University Medical Center, New York City; Smita Das, MD, PhD, chair, American Psychiatric Association Council on Addiction Psychiatry and clinical associate professor, psychiatry and behavioral sciences, Stanford University School of Medicine, Calif.; Annals of Internal Medicine, Aug. 8, 2023, online