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Occupational injuries are a serious public-health issue and cause significant morbidity and mortality in the United States. In 2004, there were 3.4 million admissions to emergency rooms for job-related injuries and illnesses, a number that reflects an estimated rate of 2.5 admissions per 100 full-time equivalent (FTE) workers aged 15 and older. In 2005, private industry employers reported 1.2 million injuries and illnesses that required days away from work, representing 135.7 per 10,000 FTE workers. The same year, data from the Census of Fatal Occupational Injuries estimated that there were approximately four occupational-injury deaths per 100,000 employed workers, which represented a total of 5,702 such deaths that year. The costs of occupational injuries and illnesses in the United States exceed $100 billion annually and entail both direct and indirect costs borne by injured workers, their families, other workers through lower wages, firms through lower profits, and consumers through higher prices. This paper describes associations between substance use and occupational injuries and proposes reasons that substance use may be linked to work-related accidents; reviews the most-recent empirical literature that has attempted to document the relationship between substance use and occupational injuries; highlights findings that are consistent across studies and addresses the limitations that most of these studies confront; examines the policies that attempt to address substance use at the workplace and why each initiative may or may not influence rates of occupational injuries; and discusses what remains unknown about the relationship between substance use and occupational injuries and identifies future avenues for research that could help fill some of these research gaps.

The research reported in this paper was sponsored by the Commonwealth of Pennsylvania and the Allegheny County Department of Human Services and was conducted within the RAND Center for Health and Safety in the Workplace (CHSW).

This report is part of the RAND occasional paper series. RAND occasional papers may include an informed perspective on a timely policy issue, a discussion of new research methodologies, essays, a paper presented at a conference, or a summary of work in progress. All RAND occasional papers undergo rigorous peer review to help ensure that they meet high standards for research quality and objectivity.

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