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The rising incidence of opioid use and its associated aftermath have been deemed a public health crisis in the U.S. The term opioid encompasses prescription opioid medication (used to treat pain, most commonly oxycodone and hydrocodone), the synthetic opioid fentanyl (used for severe pain), and heroin (an illegal opioid in the U.S.).
- opioid use
- agriculture
- mental health
- depression
- pain
- stress
1. Introduction
The rising incidence of opioid use and its associated aftermath have been deemed a public health crisis in the U.S. [1,2]. The term opioid encompasses prescription opioid medication (used to treat pain, most commonly oxycodone and hydrocodone), the synthetic opioid fentanyl (used for severe pain), and heroin (an illegal opioid in the U.S.) [3]. Although opioids can be effective for treating some painful conditions in the short term, some individuals may develop harmful opioid use or opioid use disorder.
The number of opioid prescriptions to treat pain in the U.S. rose tremendously between 1999 and 2015, increasing by nearly four-fold, which seemed to fuel the initial stages of the opioid crisis [1]. This was worrisome because the more prescriptions provided, the greater the likelihood of addiction and use of prescribed medicine by others, and those who are prescribed opioid medications are at greater risk for later using the illegal opioid heroin [1,3]. After efforts to educate physicians about the dangers of prescribing opioids and legislation to limit their use, recent statistics suggest a shift in the number of prescriptions written although overall opioid use and overdose have continued to increase [4]. It is notable that there are additional pathways to potential harmful opioid use in which the benefits and potential harms must be weighed that may or may not include initial prescription use (e.g., managing emotional pain) [3].
While the numbers of prescriptions for opioids have decreased recently, there has continued to be an alarming increase in opioid-related deaths in recent years with the rise of the use of fentanyl, and the COVID-19 pandemic also has been associated with the rise in rates [4]. According to the National Institute of Drug Abuse (NIDA), in 2020, the majority of drug overdose deaths in the U.S. (nearly 75%) were related to opioid use, accounting for over 68,000 deaths [5]. The opioid-associated number of deaths increased by more than five-fold between 2015 and 2020 [5]. Non-fatal opioid use also imposes substantial financial burden and significant consequences to individuals as well as organizations. Increases in absenteeism, slower reaction time, less productivity, more safety hazards, and higher costs for insurance are all common when there is use of opioids by personnel [6]. There are also additional societal costs, such as increased criminality and burden to the penal system, greater strain on families as evidenced by greater need for foster care, and developmental impacts on babies born addicted to opiates [7].
2. Impact on Agricultural Industries
Given the potentially destructive nature of opioids and the importance of agricultural industries to the well-being and security of U.S. residents, it is important to gain a better understanding of the impact of harmful opioid use on agricultural industries as well as areas of need for resource and program development. Levels of opioid use and associated consequences vary tremendously by location even within a given state. Indeed, opioid use and associated issues tend to vary by urban and rural areas, with differing risk factors, consequences, and resources [8]. In a survey conducted for the American Farm Bureau Federation, around 74% of those in agricultural industries reported being directly impacted by opioid use [9]. Environmental stressors, such as sun exposure, heavy lifting, long hours, weather fluctuations, and financial stress, are present to place those who work in agricultural industries in danger of harmful opioid use; the risk of injury and need for pain relief is greater while working in agricultural sectors than in many other occupations, and opioid use deaths for those in the farming, fishing, and forestry industries are more than five times higher than for the general population of workers [10,11].
While agricultural industries seem to have disproportionate experience with harmful opioid use, what remains unclear is how the prevalence of opioid use is affecting the industries themselves. Opioid use has the potential to reduce the available workforce, increase safety hazards at the worksite, increase worker turnover, and increase health issues for workers and their families. However, the extent of this impact has not yet been assessed. It is important to understand not only the extent of the problem but how specific agricultural industries might be differentially impacted. Furthermore, understanding the correlates of opioid use in agricultural industries as well as its impact on the industries and population is necessary. Recent research suggests that farmers are experiencing high rates of stress and depression; however, pain also appears to be strongly associated with harmful opioid use [12]. A further understanding of how these issues relate to opioid use among agricultural industries can help inform avenues for preventive efforts.
3. Implications for Practice
This research has the potential to benefit policy makers and practitioners regarding how to develop effective and tailored interventions for this population. First and foremost, this research demonstrated the urgent need for increased dissemination of opioid-related resources within the agricultural population. The awareness, compassion, and willingness of the participants in this sample to help those affected suggests agricultural owners to be invaluable human resources in stigma-reduction and other education campaigns. The fact that more than half of these respondents reported being unaware of helpful opioid-related resources is an unfortunate and relatively easily remedied situation. Considering agricultural owners’ awareness of the issue and the diverse ways in which they are impacted, they should be considered key stakeholders and included in discussions of community-based solutions.
Relatively high rates of pain, stress, and depression were observed in this population, and these associated conditions may represent a target for intervening prior to developing harmful opioid use or to supplement ongoing treatment of opioid use. Developing accessible, affordable, and widely distributed non-opioid pain mitigation strategies (e.g., readily available virtual support for physical pain from healthcare professionals such as physical therapists) could facilitate both education and recovery from injury without opioids. Psychological support that is also accessible and affordable in rural areas (e.g., virtual therapist meetings) could also facilitate the treatment of co-occurring mental health conditions to enable healthy lifestyle changes. Access to pharmacotherapy (e.g., methadone, buprenorphine, naltrexone), which is the standard of care for opioid use disorder and opioid use, can also be difficult to obtain in some rural areas due to long distances from treatment centers and required daily dosing. Increasing such access (e.g., more rural methadone clinics as well as access to buprenorphine and naltrexone) could have major benefits to the community in reducing the individual, psychological, industry, and financial cost of the opioid crisis particularly in rural areas and among agricultural industries. Finally, proactive engagement in preventative education regarding opioid use as well as safety-related training and kinesthetic changes to work routines can help reduce the likelihood of opioid use.
Third, this research demonstrates the need for increased support—monetary, legal, emotional/psychological, moral—for those in affected communities who do not use opioids. Employers struggling with worker use of opioids suffer monetary, legal, and moral setbacks and dilemmas that affect both their bottom line and their own psychological wellbeing. Recommended interventions, such as financial support, legal aid, and mental health services, need to be considered for affected non-users.
This entry is adapted from the peer-reviewed paper 10.3390/ijerph19095343
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