An average of 115 Americans die every day from an opioid overdose. That’s how serious this epidemic has become as rates of both prescription and non-prescription opioid use have skyrocketed since the year 2000. According to the U.S. Centers for Disease Control and Prevention (CDC), opioids were involved in 42,249 overdose deaths in 2016, accounting for 66% of all overdose deaths. This is five times the number that occurred in 1999. 

Statistics from the National Institute on Drug Abuse further demonstrate the danger of opioid use, stating that between 21 and 29 percent of those patients who are prescribed opioids misuse them, 8 to 12 percent develop an opioid use disorder and 4 to 6 percent who misuse prescription opioids transition to heroin. This emphasizes the danger of introducing prescription opioids and the potentially dire consequences if opioid use is not properly managed.

A Significant Problem in Construction

Opioid abuse has found its way into every industry, with devastating consequences. Given the demographics of its workforce and the physical nature of the work being done, the construction industry in particular has experienced firsthand the impact of opioid abuse on its workers. 

A Midwest Economic Policy Institute study found that the injury rate for construction workers is 77 percent higher than the national average, and nearly 15 percent of construction workers deal with substance abuse. Several factors, including the physical demands of construction work and the aging demographics of the workforce, contribute to these statistics. 

Furthermore, a report from the Massachusetts Department of Public Health states that, from 2011 to 2015, those employed in the construction and extraction industries accounted for 26 percent of all opioid-related overdose deaths. This calculates to 150.6 deaths per 100,000 workers, six times the average rate for all Massachusetts workers.

“This is a societal issue that’s impacting those who work on construction sites, both on the job and in their home lives as well,” says Carl Heinlein, ASSP Director-at-Large and senior safety consultant with American Contractors Insurance Group. “As we continue to work with injured employees on pain management, it has offered an in-road for opioid use, which has impacted worker health and well-being, as well as the quality of work and workers’ level of exposure to safety hazards.”

Some may think that using opioids for pain management may lead employees to return to work faster. On the contrary, a recent study found that workers who had longer-term opioid prescriptions to treat lower-back injuries were away from work three times longer than those who were not prescribed opioids.

“What’s happening is that construction workers are becoming more comfortable with taking pain medications, including opioids, and that can set them on a destructive path,” Heinlein says. “We have to take a holistic look at this, from our wellness programs, to our healthcare, to our insurance companies, to our leadership, to the workers,” says Heinlein. 

 When a worker experiences an injury on a job site, the employer faces the potential for the following scenario: The worker is prescribed a synthetic opioid to treat the pain. The worker then wants to return to the job as soon as possible, potentially taking more than the prescribed dosage in order to do so. The worker returns to the job site, even though they may not be fully recovered from the injury.

This scenario not only puts the employee in question in danger, it can also endanger the safety of other employees. Returning to the job site when not fully healthy increases the likelihood that the worker could aggravate the initial injury or suffer a different injury, potentially leading to sustained use of opioids. Furthermore, if the worker is under the influence of opioids on the job site, they could be putting coworkers in danger as well.

If contractors aren’t careful about how they handle the treatment of workplace injuries, they could find a growing number of workers grappling with substance abuse.

Workers want to get back to the job as soon as possible so that they can continue to provide for themselves and their families. However, in some cases they may be returning to work before they are physically ready to do so, leading to the possibility of increased opioid use to reduce the pain so that they can do their jobs. This can lead to create dependency on opioids to manage pain. 

Moving Forward

Faced with a crisis of this magnitude, what can contractors, medical providers, insurers and others do to prevent opioid abuse and provide help to those who misuse them or become addicted? This is a complex problem that will take a sustained, collective effort to develop solutions. From an occupational safety and health standpoint, contractors, safety professionals and others should do everything in their power to mitigate or eliminate work-site hazards to prevent workplace injuries. 

From simple measures such as conducting flex and stretch exercises before shifts, to ensuring a proper level of staffing, to utilizing prevention through design techniques to mitigate or eliminate hazards, contractors can take several preventive steps to help curtail workplace injuries, and therefore, opioid use by their workers. 

Taking this a step further, Wayne Creasap, senior director of environmental safety and health at The Association of Union Constructors, says it’s important to gather feedback from workers about how to reduce workplace injuries, as well as to provide them with information about the dangers of opioid use.

“Getting feedback from the field about the tools and techniques that would help reduce strains, sprains and the like can help tremendously in terms of what contractors are buying,” says Creasap. “Sharing information about opioids with rank and file tradespeople helps them understand the impact of what goes on in their bodies and being able to get them treated properly and getting them back to work."

When a workplace injury occurs, contractors can work with healthcare providers and insurance companies to find the most suitable solution for treating a worker’s injury. In some cases, the first reaction may be to prescribe an opioid for pain management and leave it at that. Everyone involved should instead consider what the best course of action should be, depending on the type of injury and the kind of work the individual performs on a daily basis. 

Based on these conversations, it may be that less powerful medication might be sufficient to treat the worker's pain, or that the worker may not need pain medication at all. With certain injuries, physical therapy may be the best way for the worker to recuperate so that they can get back to the job site once physically capable to do so.

“We need to do a better job of working with medical providers, explain what workers do and when they should be coming back to work,” says Heinlein. “It’s critically important to know who your medical providers are and explain to them the type of work your employees do and what your expectations are for the care your employees receive.”

All options should be explored to see that the worker gets the proper treatment. Furthermore, contractors must stay vigilant to see that workers return only when they are physically ready to do so, and that they learn the warning signs of opioid addiction, including mood swings, impulsive actions and engaging in risky activities.

For workers who are prescribed opioids, measures such as prescription drug monitoring programs provide medical professionals with guidance on a patient’s history of prescription drug use so they can make more informed decisions on what may be the best treatment for an individual’s pain management, as well as help curtail substance abuse.

All involved need to remember to focus on treatment and not just pain management. Prescribing opioids to an injured worker may be a short-term solution for managing pain, but it may not fully address treating the injury so that the worker can fully recover.

Treating Abuse and Addiction

To help those workers who are struggling with opioid abuse or addiction, open communication between management and employees is key. For too long, a stigma has surrounded opioid use, leaving many employers and workers reluctant to discuss it.  

Methods such as employee assistance programs (EAPs) and member assistance programs (MAPs) provide workers a safe and confidential avenue to discuss personal issues they are experiencing, including substance abuse. Programs like these help create a culture in which workers do not have to fear serious repercussions from their employer or union if they are dealing with substance abuse and can get the help and treatment they need to address it.

Workers need to be in an environment where they can feel comfortable speaking with their superiors about substance abuse issues, opioid or otherwise. Furthermore, employees must also feel comfortable going to management if they see warning signs of opioid abuse in a coworker.

By focusing on assistance and rehabilitation rather than punishment, contractors can create a culture in which workers can speak openly about the issues they are facing, feel supported by their employer, helping to reduce the stigma around substance abuse and turn the tide of opioid addiction.

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