Opioids

Scope

Employers are responsible for providing a safe and healthful workplace. Implementing a program to provide support and education to workers on the dangers of opioids will help minimize the chance of incidents in the workplace related to overdose or abuse.

Additionally, a naloxone use procedure can provide a vital life-saving tool to employers in the case of an overdose incident while waiting for responding emergency medical professionals. Key reasons for using naloxone include:

• Rapid response: Naloxone acts quickly, providing a prompt counter to the life-threatening effects of opioid overdose.
• Accessibility: Naloxone is relatively easy to use and can be administered without extensive medical training, making it accessible for first responders, bystanders, and even workplace settings.
• Lifesaving: By reversing the effects caused by opioids, naloxone can save lives in emergencies. It is important to note that naloxone's effects are temporary, and additional medical attention is typically required after administration.
• Prevent opioid deaths: Opioid overdoses can lead to fatal outcomes, and naloxone provides a vital tool in preventing deaths associated with opioid use.
• Community health initiatives: Naloxone distribution programs are more commonly becoming part of community health initiatives aimed at reducing the impact of the opioid epidemic.

Regulatory citations

• General Duty Clause 5(a)(1)
• 29 CFR 1910.1030 - Bloodborne Pathogens standard
• 29 CFR 1910.132 - Personal Protective Equipment standard
• 29 CFR 1910.151 - Medical Services and First Aid standard

Key definitions

• Fentanyl: Pharmaceutical fentanyl is a synthetic opioid, approved for treating
• Naloxone: A drug that can reverse the effects of opioid overdose and can be lifesaving if administered in time. The drug is sold under the brand name Narcan or Evzio.
• Opioid: Natural, synthetic, or semi-synthetic chemicals that interact with opioid receptors on nerve cells in the body and brain and reduce the intensity of pain signals and feelings of pain.
• Prescription opioids: Commonly used to treat moderate-to-severe pain and are often prescribed following surgery or injury, or for health conditions such as cancer. Common examples include oxycodone(OxyContin), hydrocodone (Vicodin), morphine, and methadone.
• Synthetic opioids: Synthetic opioids are substances that are synthesized in a laboratory and that act on the same targets in the brain as natural opioids (e.g., morphine and codeine) to produce analgesic (pain relief) effects. Common examples are methadone, tramadol, and fentanyl.

Summary of requirements

• Conduct a risk assessment: Check if workers and visitors are at risk of overdose by looking at incident reports or near misses. Identify staff who are willing to use naloxone and work with local healthcare professionals to address broader opioid issues in the area.
• Consider liability: Talk to your insurance company about legal concerns. Know the naloxone laws in your area and understand your state's Good Samaritan Laws that protect those providing medical help in good faith.
• Manage records: Establish formal procedures for documenting incidents, managing incident records, and maintaining employee training records.
• Define staff roles: Define the roles and responsibilities of those who respond to a suspected overdose. Include updates to current medical response procedures to include naloxone use.
• Train staff: Provide training to employees to identify indicators of opioid overdose and promptly call 9-1-1. Training should also include:
  • Information on the dangers of drug powders/residues, using personal protective equipment (PPE), and assessing the scene before entering;
  • Procedures to follow when administering naloxone and addressing any issues during response;
  • Steps to prepare for exposure risks and applicable vaccinations; and
  • Annual refresher training, combined with other certifications (e.g., first aid, CPR, etc.).
• Purchase naloxone: Choose nasal sprays or injectable forms that can be given with an auto-injector, pre-filled syringe, or a regular syringe/needle. Research has shown that people trained on intranasal spray reported higher confidence in administration. Keep at least two doses because sometimes one isn't enough to stop an overdose. Consider how long it takes to get more supplies when deciding how many doses to have.
• Store naloxone: Follow the instructions from the manufacturer. Keep it in places where it is readily accessible. Check the expiration date and replace it on time.
• Acquire and maintain adequate PPE: Keep personal protective equipment near naloxone for a fast response. Have fentanyl-resistant gloves, a rescue mask, face shield, or bag valve mask, and sharps disposal containers if using injectable naloxone.
• Develop follow-up care planning: Partner with healthcare providers to create a plan for quick and ongoing care for any worker who suffers an overdose. Make sure there's help and support for those administering the naloxone and any bystanders if needed.
• Maintain your program: Regularly check and update your program. Add any new medical and emergency response advice as it comes out.