The proportion of synthetic opioid overdose deaths co-involving stimulants has increased in the United States in recent years. Although persons who use opioids have reported increasing stimulant co-use to maintain workplace productivity and alertness, occupational patterns of co-involvement in fatal overdose have not been systematically investigated. In an exploratory study, data on overdose deaths involving synthetic opioids (e.g., fentanyl) from the 2022 National Vital Statistics System were analyzed to characterize patterns of stimulant co-involvement among U.S. residents aged 15-64 years, stratified by decedents' usual occupation and industry. Of 69,893 fatal synthetic opioid overdoses, 53.6% involved stimulants. Occupation and industry groups with the highest percentages of synthetic opioid overdose deaths co-involving psychostimulants with abuse potential (psychostimulants) were typically physically demanding (e.g., construction and extraction occupations), whereas categories with highest percentages of cocaine co-involvement were generally less physically strenuous (e.g., business and financial occupations); these patterns might reflect differences in desired drug effects, cost, and geographic availability. Work-related interventions might be useful in preventing the development of substance use disorder by decreasing rates of occupational injuries and workplace stress, connecting workers with substance use disorder to treatment resources, and reducing fatal overdose through harm reduction.
