Prescription Opioid and Benzodiazepine Medications and Occupational Safety and Health: Information for Employers and Healthcare Providers

Prescription Opioid and Benzodiazepine

Medications and Occupational Safety and Health

Information for Employers and Healthcare Providers

Prescription opioid medications intended for pain management and

prescription benzodiazepines for conditions such as anxiety or in-

somnia, when used alone or together, often have side effects that

can affect workers’ health and safety. In addition, some occupational

factors, such as work-related motor vehicle crashes, falls, other

injuries and job stress, have the potential to increase the chances

that a worker is given a prescription for an opioid or benzodiazepine

[Kowalski-McGraw et al. 2017].

The Centers for Disease Control and Prevention (CDC) has developed

resources for improving communication between clinicians and

patients about the risks and benets of opioid therapy for pain,

improving the safety and effectiveness of pain treatment, and re-

ducing the risks associated with long-term opioid therapy, including

opioid use disorder (a problematic pattern of opioid use that causes

signicant impairment or distress), overdose, and death. In some

cases, prescriptions could be an initial or single one. In other cases,

an opioid and/or benzodiazepine prescription could be the starting

point for increasing and/or long-term use.

This fact sheet summarizes ndings from the scientic literature

[Kowalski-McGraw et al. 2017] and provides information from rele-

vant CDC and National Institute for Occupational Safety and Health

(NIOSH) publications for employers and healthcare providers about

the prescription use of opioids and benzodiazepines.

What are some side effects of prescription

opioid or benzodiazepine use?

 Sedation: feelings of sleepiness and dizziness can happen

when starting or continuing to take these medications.

Sedation may lead to diminished alertness, responsiveness,

impaired decision-making, or injury.

 Movement and coordination: the use of prescription opioids

and benzodiazepines is associated with both physical and

cognitive impairment. Physical and cognitive impairment is

a slowing-down of the coordination of thoughts and phys-

ical movements, which can be associated with an increased

risk for errors and injuries.

Centers for Disease Control

and Prevention

National Institute for Occupational

Safety and Health

Prescription Opioid and Benzodiazepine Medications and Occupational Safety and Health

 Memory: certain benzodiazepines may lead to short and long-term memory

problems. Memory issues can also occur with long-term prescription opioid

use.

 Strength and posture: prescription opioids and benzodiazepines may impair

a person’s ability to control their posture and may lead to falls. The pre-

scription use of opioids and benzodiazepines among older adults is associ-

ated with an increased risk of falls and hip fractures from falls.

What are some occupational factors associated with the

use of prescription opioids or benzodiazepines?

 Ergonomic hazards (such as heavy manual labor) leading to injuries, or

repetitive use of the hands leading to other chronic painful conditions,

might be treated with both of these medications.

 Risky workplace conditions that lead to injury, such as slip, trip, or fall hazards,

or heavy physical workloads can be associated with prescription opioid use.

 Factors such as job insecurity, high-demand/low-control jobs, and work-

place bullying are associated with anxiety disorder and depression [Kowalski-

McGraw et al. 2017], which may be treated with prescription benzodiaz-

epine medication.

How can the use of prescription opioids or

benzodiazepines affect people at work?

 The use of prescription opioid and/or benzodiazepine drugs may negatively

affect the performance of safety-sensitive tasks, such as driving or operat-

ing machinery.

 The use of opioids, even when taken as prescribed, is linked to risky driving

behaviors and a higher risk of motor vehicle crashes.

 The use of prescription opioids or benzodiazepines may increase the risk of

falls among workers, a common cause of workplace injuries.

 The use of prescription opioid or benzodiazepine drugs can decrease per-

formance in tasks that require brain-eye-hand coordination. Work-related

fatigue (for example, from shiftwork or long work hours) could worsen this

performance loss.

What might healthcare professionals keep in mind?

 Consult currently available resources regarding recommendations pertain-

ing to prescribing opioid pain medication or benzodiazepines, including

the following [CDC 2016a,b, 2019]:

o CDC Guideline for Prescribing Opioids for Chronic Pain

o CDC handout: Guideline for Prescribing Opioids for Chronic Pain:

Promoting Patient Care and Safety

Prescription Opioid and Benzodiazepine Medications and Occupational Safety and Health

o CDC webpage: Improve Opioid Prescribing

 Nonpharmacologic therapy and non-opioid pharmacologic therapy are

preferred for chronic pain outside of active cancer, palliative, and end-of-

life care.

 If opioid pain therapy is necessary, the lowest possible effective dosage

should be prescribed to reduce the risk of opioid use disorder and overdose.

Prescribers should refer to CDC guidelines.

o Exercise caution when prescribing opioids and monitor all patients closely.

o Establish goals for pain and function.

o Discuss risks and benets.

 Use immediate-release opioids when starting.

o Use the lowest effective dosage.

o Prescribe a limited quantity for a short duration when managing acute

pain: Three days’ supply or less will often be sufcient; more than 7 days’

supply will rarely be needed.

 Evaluate benets and harms frequently.

 Use strategies to mitigate risk, e.g., education.

 Review prescription drug monitoring program data.

 Avoid concurrent opioid or benzodiazepine prescribing whenever possible.

 Ensure that the patient is not receiving the same prescriptions from

multiple providers.

 Adhere to HIPAA guidelines for employee privacy.

 Consult other prescribing recommendations [see Hegmann et al. 2014].

 Offer or arrange treatment for opioid use disorder.

What might employers keep in mind?

 Continue efforts to optimize worker safety, health, and well-being, and

consider opportunities to reduce risks for work-related motor vehicle crashes,

falls, other injuries and job stress.

 Refer to the following NIOSH publications about the importance of

preventing and reducing work-related hazards [NIOSH 1997, 1999, 2000,

2015]:

o Elements of Ergonomics Programs

o Stress at Work

o Worker Deaths by Falls: A Summary of Surveillance Findings and

Case Reports

o Preventing Work-Related Motor Vehicle Crashes

Prescription Opioid and Benzodiazepine Medications and Occupational Safety and Health

Acknowledgments

This document was prepared by Sudha P. Pandalai, MD, PhD; Paul A. Schulte, PhD;

and Susan E. Afanuh, National Institute for Occupational Safety and Health.

The authors acknowledge Michele Kowalski-McGraw, MD, MPH, and Judith

Green-McKenzie, MD, MPH, for subject matter input.

Resources

More information about the use of opioids and other prescription drugs can be

found at Kowalski-McGraw M, Green-McKenzie J, Pandalai S, Schulte P [2017].

Characterizing the interrelationships of prescription opioid and benzodiaze-

pine medications with worker health and workplace hazards. J Occup Med

59(11):1114–1126. http://dx.doi.org/10.1097/JOM.0000000000001154

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goverdose/pdf/Guidelines_At-A-Glance-a.pdf

CDC [2016b]. CDC guideline for prescribing opioids for chronic pain—United

States, 2016. By Dowell D, Haegerich TM, Chou R. MMWR Recommendations

and Reports 65(1):1–49. https://doi.org/10.15585/mmwr.rr6501e1er

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Suggested Citation

NIOSH [2021]. Prescription opioid and benzodiazepine medications and occu-

pational safety and health: information for employers and healthcare providers.

By Pandalai SP, Schulte PA, Afanuh SE. Cincinnati, OH: U.S. Department of

Health and Human Services, Centers for Disease Control and Prevention,

National Institute for Occupational Safety and Health, DHHS (NIOSH) Publica-

tion No. 2021-116. https://doi.org/10.26616/NIOSHPUB2021116

DHHS (NIOSH) Publication No. 2021-116

DOI: https://doi.org/10.26616/NIOSHPUB2021116

May 2021