Construction companies urged to address industry’s opioid problem
The single leading cause of death among construction workers is driving some health professionals and construction companies to advance big changes in workplace culture, policies and support programs.
Analysis released by the Centers for Disease Control and Prevention (CDC) earlier this year identified drug overdose as the leading cause – by far – of deaths in the industry. A comprehensive examination of overdose deaths by occupation, the CDC study found 162 overdose deaths per 100,000 construction workers in 2020 (the most recent year for which data was available).
By comparison, total on-the-job deaths reported among construction workers the same year was 10 per 100,000, according to the U.S. Department of Labor. Consequently, a construction worker was 16 times more likely to die from a drug overdose than a worksite accident.
In Maryland, the statistics are even worse.
Earlier research conducted by an interdisciplinary team at the University of Maryland, Baltimore for the Maryland Department of Health found 212 overdose deaths in 2018 per 100,000 construction workers in the state.
In both the CDC and Maryland studies, construction had the highest rates of overdose deaths among all industries. In the CDC study, the food service industry ranked second with 118 overdose deaths per 100,000 workers. In Maryland, the material moving industry (transportation and warehousing) ranked second with fewer than 100 deaths per 100,000 workers.
Multiple factors contribute to the high rate of drug issues, especially opioid use, in the construction industry, said Dr. Jodi Frey, Professor and Associate Dean for Research at the University of Maryland, Baltimore School of Social Work. Frey is also lead author of the Maryland overdose study.
Physical labor, worksite hazards and injuries fuel the need for painkillers. Meanwhile, limited access to health insurance and paid sick leave “create the desire and pressure to get back to work faster and that can result in using medications that have more addictive properties,” Frey said.
In response to the opioid crisis and high overdose deaths, public health and labor professionals in multiple states have developed protocols for creating the Recovery Friendly Workplace (RFW) in recent years. RFW models provide employers with guidance and resources to support individuals with opioid use disorder (OUD), and support individuals at risk of developing a substance-misuse problem.
Components of a RFW can be as fundamental and proactive as “helping construction workers become more informed healthcare consumers and understand the risk of that second opioid prescription,” said Dr. Marianne Cloeren, Associate Professor at the University of Maryland, Baltimore School of Medicine and co-author of the Maryland overdose study.
Cloeren and Frey have been supporting the Maryland Departments of Labor and Health in developing and piloting an RFW program for the State of Maryland.
Other aspects of an RFW for construction can include:
• Toolbox talks and other education for managers and workers on substance use and misuse, how to identify a person at risk and how to talk about the issue;
• Supplies of naloxone (better known by the brand name Narcan) and training for staff on how to use the medication to reverse an opioid overdose;
• Healthcare benefits and employee assistance programs (EAPs) that provide referral and support for inpatient and outpatient substance use disorder treatment, mental health and wellness programs, in addition to referrals for physical therapy.
“Many employers are already doing some things that contribute to a Recovery Friendly Workplace,” Frey said. However, “becoming a true Recovery Friendly Workplace is comprehensive and it requires an investment over time. It’s not a one-time training and you can check a box.”
Creating a robust RFW requires employers to identify areas where their practices and policies don’t support individuals with opioid use or other substance use disorders.
“You even have to think about things like if all your company events are centered around alcohol, how does that play out for people who are in recovery,” Cloeren said. “You have to try to be more consciously inclusive.”
Employers, she added, need to look at their policies impacting recruitment and ask whether those policies would dissuade a person recovering from an opioid use disorder from submitting a job application.
The construction industry, Frey said, became a leader in adopting some RFW approaches after data became available on overdose rates.
“Having data is critically important to help leaders within workplaces recognize that some public health crises are also workplace concerns,” Frey said.
The industry, however, still has work to do to become recovery friendly.
Providing expanded health insurance, paid time off and naloxone supplies is a heavy financial lift, Cloeren said. And the organization of the construction industry makes it more difficult to provide those supports.
“The large general contractors recognize the need and have the safety teams to address this,” Cloeren said. “But the employees who are most at risk, are not the GC’s employees. They are people working for often small subcontractors.”
Individuals with opioid use disorder also still face considerable stigma, Cloeren added. For example, a person recovering from a heart attack would normally be welcomed back to a workplace. A person recovering from opioid use disorder may not get as warm of a welcome.
Multiple online resources provide further information about the opioid crisis and Recovery Friendly Workplaces, including guidance and toolkits.
• National Safety Council Opioids Home – National Safety Council
• U.S. Department of Labor Recovery-Ready Workplace Toolkit | U.S. Department of Labor