To the Editor, We appreciate Robinson et al.'s recent analysis of the disproportionate health risks faced by miners, including that of work-related pain. 1 As investigators in this area, we share their concern that miners are at disproportionate risk of iatrogenic overexposure to opioids due to their physically-demanding jobs and high risk for musculoskeletal injury. We are also concerned that miners may be left behind as public health intervention to reduce opioid-related harms pivots almost entirely toward the illicit-trafficking of fentanyl and heroin as the on-going source of the crisis. 2,3 In 2018, the Workers' Compensation Research Institute found that miners were more likely to receive opioids for injuries, in stronger doses and over longer periods of time. 4 While opioid prescribing has declined for the United States population overall, we fear that miners' health care still commonly includes treatment with opioids, putting them at risk of addiction, overdose, and misuse. And more opioid prescription fills put not only miners at risk, but also their family members and their community. 5