Worldwide, about 600,000 deaths were attributable to drug overdose in 2019 (WHO, 2025). Evidence suggests that the risk of overdose is elevated among some healthcare workers (HCWs). One population-based cohort study in the United States of America, for example, found that counsellors, social workers, psychologists, and other community and social service workers have more than twice the risk of fatal drug overdose as people working outside of healthcare (Olfson et al., 2023). Others estimate that 8-15% of physicians live with substance use disorder (SUD) (Samuelson & Bryson, 2017).
There is an increased risk of fatal drug overdose in HCWs, but there is a dearth of qualitative research exploring what might contribute to this problem. This may be explained by the reluctance of HCWs experiencing SUD to participate in interviews/focus groups because of stigma, denial of the disease, psychiatric comorbidities, and the fear of professional and social reprimand (Vayr et al. 2019).
However, there are specific ‘occupational hazards’ that might increase HCWs’ vulnerability to substance use. This includes that many HCWs have knowledge of and direct access to a range of medications, including opioids, which pose a high-risk for dependency (Mielau et al., 2021). Compounding this risk is the high level of stress, burnout, anxiety, and depression experienced by many HCWs, often resulting from long working hours, high patient demand, unfair pay, and vicarious trauma from experiencing recurrent and prolonged patient suffering (Teoh et al., 2024; Olaya et al., 2021).
Addressing this knowledge gap is a necessary step toward developing evidence-based strategies for overdose prevention and targeted support for HCWs living with SUD. In this blog, I summarise the mixed-methods study by Algahtani et al. (2024), which aimed to “identify factors that contribute to fatal overdose in healthcare professionals, both intentional and accidental, and guide recommendations for harm reduction.”
The risk of fatal drug overdose is elevated in healthcare workers, but the factors driving this are poorly understood because of stigma, denial, and fear of professional reprimand.
Methods
As there is difficulty collecting data directly from HCWs experiencing SUD, the researchers collected data from the National Programme on Substance Use Mortality (NPSUM). They used a systematic strategy to search for reported deaths of HCWs where illicit substances and licensed medications (excluding nicotine, caffeine, and alcohol when not co-implicated with other substances) were responsible (NPSUM, n.d.). They included students, retirees, and HCWs who had left the profession in their search, but excluded veterinary HCWs.
Deaths are voluntarily reported to the NPSUM by coroners in England, Wales, and Northern Ireland and are based on healthcare records, postmortem investigations, and reports from witnesses, family and friends, and emergency services. Reports from 1st January 2000-31st December 2022 were sampled.
The analysis followed a mixed-methods approach. The authors used descriptive statistics to summarise the demographics of the HCWs, the circumstances of their deaths, and the drugs involved. Free-text data were analysed qualitatively to create themes that identified the factors that may have contributed to the HCWs fatal drug overdose.
Results
Demographics of healthcare workers
58 reports were included in the analysis. They comprised: 47 (81%) employed as HCWs at the time of their death; 3 (5%) retirees; 4 (7%) on long-term sick leave; 2 (3%) students; 2 (3%) non-clinical staff. Median age was 38 years, and 39 (67%) were male. Doctors were the largest group (48%, n=28). This included 9 anaesthetists, 5 General Practitioners (GPs), and 13 with unknown specialities. Deaths were categorised as suicide in 28 (48%) cases, accidental in 24 (41%) cases, and undetermined in 6 (10%) cases. Opioids were the most frequently implicated drug, cited in 25 (43%) cases, followed by benzodiazepines in 14 (24%) cases. The remaining three deaths were attributed to illicit drugs, with each case co-implicated with licensed medications.
Mental and Physical Health Problems
The authors identified several factors under the umbrella of mental and physical health problems that could have contributed to the HCWs’ fatal drug overdose. 29 (50%) HCWs had a mental health condition, with some being in contact with psychiatric services days before their death. 28 (48%) alluded to a recent deterioration in mental health, frequently attributed to work-related pressures such as excessive overtime, treating patients who had experienced significant trauma, and allegations of professional misconduct. In terms of physical health problems, self-medicating to relieve chronic pain was described in 8 (14%) cases. For some HCWs, substance use only became apparent post-mortem; for example, one coroner found lesions on a nurse’s wrist (suggestive of intravenous (IV) use), who did not seem to have a history of SUD.
Vocational Factors – What I Perceived to Be ‘Occupational Hazards’
The authors identified three vocational factors that may have contributed to the HCWs fatal drug overdose. I interpreted these findings as depicting occupational hazards, highlighting risks within the healthcare profession that uniquely make HCWs vulnerable to fatal drug overdose. First was that 37 (64%) HCWs (including non-clinicians and retired HCWs) sourced the drug from their workplace. One retired pharmacist, for example, had retained medications from his former workplace with the perceived intent to die by suicide. The second was that 32 (55%) of HCWs used their clinical knowledge to administer the drugs using equipment taken from their workplace like intravenous lines (IVs), syringes, cannulas, and tourniquets and to manage side effects. In one inquest, the coroner explained:
“[the HCP] would have had a good working knowledge of anaesthetic drugs used in surgical procedures and would have known that the drugs they injected themselves with would cause them to lose consciousness and stop breathing.”
The final occupational hazard present in 16 (28%) cases was the attainment of private prescriptions from less-regulated sources outside the UK. These reports provided another example of HCWs’ using their clinical knowledge to influence what was prescribed.
Fatal drug overdoses in healthcare workers may have resulted from an intersection of declining mental health, self-medication for pain, and occupational hazards unique to their profession.
Conclusion
There are occupational hazards that can contribute to fatal drug overdose among HCWs. These include that HCWs have access to controlled substances, knowledge of dosing and managing side effects, and the power to obtain prescriptions from less-regulated sources outside the UK. Poor mental health, excessive working hours, and vicarious trauma from experiencing patient suffering also contribute.
These findings affirm evidence that SUD is not a defect of character or personal failure, but is instead systemically embedded within the healthcare occupation (Wakeman et al., 2017). As such, healthcare institutions have an opportunity to co-develop proactive prevention and support strategies with HCWs for those at risk of, or experiencing SUD.
This study highlights how addressing the risk of fatal drug overdose among HCWs requires a systemic approach from healthcare institutions, rather than solely individual action.
Strengths and Limitations
I believe the main strengths of this study were that entries into the NPSUM include healthcare records and emergency service reports. The inclusion of sources that were documented immediately after the HCWs’ deaths may have reduced recall bias (witnesses misremembered an experience) compared to if all witnesses were interviewed retrospectively. The NPSUM draws data from multiple sources. This may have offered a fuller picture of the factors contributing to the HCWs’ fatal drug overdose than possible by interviewing a single person.
However, one of the main limitations of this study was that reports on veterinary HCWs were excluded. Veterinary HCWs have similar access to psychoactive medications and have a high incidence of work-related stress, burnout, anxiety, and depression so it is possible that the findings are transferable (Pohl et al., 2022). Coroners are not required to report deaths to the NPSUM. Other factors contributing to the HCP’s fatal drug overdose may not have been captured by this study.
The NPSUM is based on reports from witnesses, emergency services, and people within the HCWs’ personal network. While the data sources may corroborate each other, the information is still subject to social desirability bias (witnesses reporting information perceived as favourable to the data collector). In addition, these reports may not fully capture the factors the HCWs themselves would have viewed as contributing to their fatal drug overdose. Reports from the NPSUM can vary in detail, and the results offered here were primarily summarised using descriptive statistics and with few data extracts. As a consequence of this, the results may have offered less depth than possible with interviews or focus groups.
While data was collected from the National Programme on Substance Use Mortality, the brevity of the reports and the summative nature of the analysis limits our understanding.
Implications
Accessible and evidence-based mental health and addiction support, potentially as part of an employee assistance programme, could be the first step to supporting HCWs experiencing SUD. While fear or stigma and professional reprimand may prevent some from accessing this support (Vayr et al. 2019), systematic reviews show that, once engaged, HCWs are responsive to these interventions and their return-to-work after recovering is achievable, sustainable, and safe (Kunyk et al., 2016).
The key to success, therefore, may be to create a working environment that encourages HCWs to access this support. This could be achieved by involving HCWs with lived experience of SUD and addiction in the co-design of awareness resources. In addition, curricula in undergraduate medical school, and foundation and speciality training may benefit from emphasising that SUD is an addiction and health condition that requires support, not a personal failure or a choice as some HCWs have reported in qualitative studies (Boekel et al., 2013).
Healthcare workers may benefit from access to internal mental health and addiction services, but uptake is contingent upon fostering a non-stigmatising workplace culture.
Statement of Interest
Amelia is currently conducting a post-doc on mental health and addiction research. No conflicts of interest to declare.
Edited by
Dafni Katsampa.
Links
Primary Paper
Algahtani, T., Gee, S., Shah, A., Williams, B. D., Gorton, H. C., Welch, S., & Copeland, C. S. (2025). Fatal drug overdoses in healthcare workers: A thematic framework analysis of coroner reports. Addiction, 120(11), 2270-2281. DOI: https://doi.org/10.1111/add.70139
Other References
Kunyk, D., Inness, M., Reisdorfer, E., Morris, H., & Chambers, T. (2016). Help seeking by health professionals for addiction: A mixed studies review. International Journal of Nursing Studies, 60, 200-215. https://doi.org/10.1016/j.ijnurstu.2016.05.001
Mielau, J., Vogel, M., Gutwinski, S., & Mick, I. (2021). New approaches in drug dependence: opioids. Current addiction reports, 8(2), 298-305. https://doi.org/10.1007/s40429-021-00373-9
Olaya, B., Perez-Moreno, M., Bueno-Notivol, J., Gracia-Garcia, P., Lasheras, I., & Santabarbara, J. (2021). Prevalence of depression among healthcare workers during the COVID-19 outbreak: a systematic review and meta-analysis. Journal of clinical medicine, 10(15), 3406. https://doi.org/10.3390/jcm10153406
Olfson, M., Cosgrove, C. M., Wall, M. M., & Blanco, C. (2023). Fatal drug overdose risks of health care workers in the United States: a population-based cohort study. Annals of internal medicine, 176(8), 1081-1088. https://doi.org/10.7326/M23-0902
Pohl, R., Botscharow, J., Böckelmann, I., & Thielmann, B. (2022). Stress and strain among veterinarians: a scoping review. Irish Veterinary Journal, 75(1), 15. https://doi.org/10.1186/s13620-022-00220-x
Samuelson, S. T., & Bryson, E. O. (2017). The impaired anesthesiologist: what you should know about substance abuse. Canadian Journal of Anesthesia/Journal canadien d’anesthésie, 64(2), 219-235. https://doi.org/10.1007/s12630-016-0780-1
Teoh, K. R. H., Dunning, A., Taylor, A. K., Gopfert, A., Chew-Graham, C. A., Spiers, J., … & Riley, R. (2024). Working conditions, psychological distress and suicidal ideation: cross-sectional survey study of UK junior doctors. BJPsych open, 10(1), e14. https://doi.org/10.1192/bjo.2023.619
The National Programme on Substance Use Mortality (NPSUM). (n.d.). The National Programme on Substance Use Mortality – King’s College London. https://www.kcl.ac.uk/research/the-national-programme-on-substance-use-mortality
Van Boekel, L. C., Brouwers, E. P., Van Weeghel, J., & Garretsen, H. F. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and alcohol dependence, 131(1-2), 23-35. https://doi.org/10.1016/j.drugalcdep.2013.02.018
Vayr, F., Herin, F., Jullian, B., Soulat, J. M., & Franchitto, N. (2019). Barriers to seeking help for physicians with substance use disorder: a review. Drug and alcohol dependence, 199, 116-121. https://doi.org/10.1016/j.drugalcdep.2019.04.004
Wakeman, S. E., Kanter, G. P., & Donelan, K. (2017). Institutional substance use disorder intervention improves general internist preparedness, attitudes, and clinical practice. Journal of Addiction Medicine, 11(4), 308-314.https://doi.org/10.1097/ADM.0000000000000314
World Health Organisation. (2025) Opioid overdose. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
