Opioid addiction: The epidemic’s impact on firefighters

Five reasons firefighters are at an increased risk of opioid abuse


Researchers have detailed how opioid use often begins with prescription medications, then devolves to street drugs when the prescriptions run out.


The opioid epidemic in the U.S. is no secret, especially not to the first responders who see the impact of addiction while responding to an increasing number of overdose calls.

It’s natural to think of first responders in this frontline role, but the question remains: How is the opioid epidemic affecting first responders – personally?

In July 2020, a Charleston, West Virginia, firefighter-paramedic died of an accidental overdose at the station, highlighting was many believe to be a growing concern within in the public safety community. The firefighter-medic’s chief echoed the impact of the shift beyond the first responder role: “As first responders, we deal with death daily, but when it’s one of your brothers, it’s a whole different ballgame.”

An increased risk of addiction

While early discussions around opioid abuse focused on illegally obtained substances like heroin, the abuse turned epidemic largely due to the far-more-readily-available prescription medications. Researchers have detailed how opioid use often begins with prescription medications, then devolves to street drugs when the prescriptions run out.

To date, there is no available published research on the rates of opioid use among first responder groups, so quantifying the risk is not possible. However, it is important to recognize that first responders are at a high risk for opioid addiction for several reasons:

1. High risk of injury: Firefighters and other first responders are at a high risk of injury, which means they are more likely than many others to need treatment for pain in the course of injury-management.

2. Risky health behavior: Firefighters do report risky health behaviors and high rates of substance use in general. For instance, in a sample of Midwest firefighters, approximately 50% of both career and volunteer firefighters reported binge drinking behavior, and approximately 10% reported driving while under the influence in the past 30 days. [Read next: Firefighters and alcohol: What the data says]

3. Exposure to stressors: Firefighters are exposed to several stressors, both through their job and through the impact that shift work and being exposed to trauma on a regular basis has on their families and social support networks.

4. Behavioral health concerns: Firefighters are at high risk for several behavioral health concerns such as depression, anxiety and post-traumatic stress injury, which often co-occur with opioid addiction.

5. Sleep issues. Firefighters have a high rate of sleep disorders and sleep issues also put people at higher risk of substance use and abuse. Often people use or abuse medications to help them sleep. In turn, substance abuse can lead to more disordered sleeping.

A review of available treatment resources also finds a number that are specifically focused on treating firefighters who are struggling with substance use, including opioids, which suggests there is a need for this type of help, even if it is not being discussed around the kitchen table. The IAFF’s Center of Excellence, a treatment facility designed specifically for the treatment of substance abuse and behavioral health issues, also includes a specific focus on opioid addiction and abuse.

How to recognize the signs of opioid addiction

Recognizing opioid addiction can be a challenge, particularly given that people can slide into addiction gradually and experience or exhibit symptoms over time. While firefighters can easily recognize addiction and overdoses when they show up on scene to treat a patient, recognizing addiction in colleagues – or even yourself – can be more of a challenge.

The Center of Excellence offers tips for recognizing opioid addiction among other firefighters:

  • Physical changes include constricted pupils, flushed skin, unexplained weight loss, struggling to stay awake or slowed thinking.
  • Emotional changes include withdrawing, quick mood changes or intense mood swings, or increased impulsivity.
  • Behavioral changes include taking medications not as prescribed (more frequently or at higher doses), losing medication or trying to borrow medication from others, engaging in other risky behaviors, medication-seeking by visiting different providers, and taking medicine “just in case,” even when pain is not present.

The key component of the addiction is the drive to take the drug as a way to avoid withdrawal systems or being uncomfortable.

Understand that treating opioid addiction takes a long-term approach that usually begins with detoxing the body – a process that should occur under medical supervision.

Speak up

If you think you see addiction in one of your crewmembers, it is important to speak up. Whether it is raising the issue with the member directly, through a peer team member, or someone close to the first responder, the risks of overlooking an addiction are too high to do something.

Sara Jahnke, PhD, is the director and a senior scientist with the Center for Fire, Rescue & EMS Health Research at the National Development & Research Institutes - USA. With over a decade of research experience on firefighter health, Dr. Jahnke has been the principal investigator on 10 national studies as well as dozens of studies as a co-investigator. Her work has focused on a range of health concerns, including the health of female firefighters, behavioral health, risk of injury, cancer, cardiovascular risk factors, and substance use, with funding from the Assistance to Firefighters Grant R&D Program, the National Institutes of Health and other foundations. Jahnke has more than 100 publications in the peer-reviewed medical literature. Awards include the 2019 Endowed Lecture at the annual conference of the American College of Epidemiology; the 2018 President’s Award for Excellence in Fire Service Research as well as the Excellence in Research, Safety, Health & Survival Award, both from the International Association of Fire Chiefs (IAFC); and the 2016 John Granito Award for Excellence in Firefighter Research from the International Journal of Fire Service Leadership and Management. Connect with Jahnke on LinkedIn, Twitter or via email.