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Characterizing the Interrelationships of Prescription Opioid and Benzodiazepine Drugs With Worker Health and Workplace Hazards

Kowalski-McGraw, Michele MD, MPH; Green-McKenzie, Judith MD, MPH; Pandalai, Sudha P. MD, PhD; Schulte, Paul A. PhD

Journal of Occupational and Environmental Medicine: November 2017 - Volume 59 - Issue 11 - p 1114–1126
doi: 10.1097/JOM.0000000000001154
Original Articles

Objective: Prescription opioid and benzodiazepine drug use, which has risen significantly, can affect worker health. Exploration of the scientific literature assessed (1) interrelationships of such drug use, occupational risk factors, and illness and injury, and (2) occupational and personal risk factor combinations that can affect their use.

Methods: The scientific literature from 2000 to 2015 was searched to determine any interrelationships.

Results: Evidence for eight conceptual models emerged based on the search yield of 133 articles. These models summarize interrelationships among prescription opioid and benzodiazepine use with occupational injury and illness. Factors associated with the use of these drugs included fatigue, impaired cognition, falls, motor vehicle crashes, and the use of multiple providers.

Conclusion: Prescription opioid and benzodiazepine drugs may be both a personal risk factor for work-related injury and a consequence of workplace exposures.

The Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Drs Kowalski-McGraw, Green-McKenzie); Geisinger Health, Wilkes Barre, Pennsylvania (Dr Kowalski-McGraw); and The Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio (Drs Pandalai, Schulte).

Address correspondence to: Judith Green-McKenzie, MD, MPH, Division of Occupational and Environmental Medicine, Ground Floor Silverstein, 3400 Spruce Street, Philadelphia, PA 19104-4283 (

At the time of the research, MKM was a resident in Occupational Medicine at the University of Pennsylvania Perelman School of Medicine. MKM is currently Chief Medical Director of Employee Health/Occupational Medicine at Geisinger Health. JGM is Division Chief, Professor and Residency Program Director, Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania. SP is Medical Officer at The Centers for Disease Control and Prevention/NIOSH/Education and Information Division/Risk Evaluation Branch. PS is Director, Education and Information Division, NIOSH in the Centers for Disease Control and Prevention.

This research was supported in part by training grants from the National Institute of Occupational Safety and Health, grant number: 5-TO1-0H008628, and the Health Resources and services Administration, grant number: D33HP25770-01-00.

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the National Institute for Occupational Safety and Health or the University of Pennsylvania.

The authors disclose no conflicts of interest.

Copyright © 2017 by the American College of Occupational and Environmental Medicine