Opioid use disorder, job strain, and high physical job demands in US workers

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Little is known about the work environmental risk factors for opioid use disorder (OUD) in working populations. The purpose of this study is to examine whether adverse physical and psychosocial working conditions are associated with OUD in a working population of the United States (US).


Among the participants of the National Survey of Midlife Development in the United States (MIDUS) II Study (2004–2006), 2134 workers (1059 men and 1075 women; mean age, 51 years) were chosen for this study. OUD was measured with self-administered questions in line with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSD-5). Physical demands (physical efforts, heavy lifting, and crouching/stooping/kneeling) and psychosocial work stressors (skill discretion, decision authority, job control, psychological job demands, supervisor and coworker support at work, job insecurity, and work hours) were measured with a standard questionnaire.


The prevalence of OUD was 3.8%. In multivariate analyses, low skill discretion, high psychological job demands, job strain (a combination of low control and high demands), and high physical job demands were significantly associated with OUD. The multivariate prevalence ratios for OUD by job strain and frequent heavy lifting were 1.98 (1.27–3.10) and 2.23 (1.22–4.10), respectively. Job strain was more strongly associated with OUD in men, while high physical job demands were more strongly associated with OUD in women.


This study implies that adverse physical and psychosocial working conditions may be important risk factors for OUD in US working populations. Future longitudinal and mechanistic studies are urgently warranted.

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Correspondence to BongKyoo Choi.

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The studies have been approved by the appropriate institutional and/or national research ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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This study was based on de-identified data from the MIDUS II study in which informed written consent was obtained from all participants.

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Choi, B. Opioid use disorder, job strain, and high physical job demands in US workers. Int Arch Occup Environ Health (2020) doi:10.1007/s00420-019-01514-4

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  • Opioid
  • Physical demands
  • Job strain
  • Psychosocial
  • United States