It’s been clear for a while now that the opioid epidemic is having an alarming impact on construction workers. There are several reasons for this, but a major one is that year after year, construction continues to rank among the most dangerous occupations. Serious injuries are often treated with prescription painkillers, putting construction workers at risk for opioid dependence, addiction and even death.

Until recently, it has been difficult to put a number on that impact. We have known construction workers were at greater risk for opioid misuse than other occupations – but how much more, exactly? In our March issue, we shared data showing that construction workers in Ohio were seven times more likely to die of an opioid overdose than workers in other professions.

Now, a new report from the Massachusetts Department of Public Health (MDPH) is showing just how deadly opioids have been for construction workers in the Bay State. The report examined fatal overdoses in the state by occupation between 2011-2015 and found that construction workers accounted for more than 24 percent of opioid-related deaths. Construction workers had the highest rate of opioid overdose of any profession and were six times more likely to die of an opioid overdose than the average Massachusetts worker. In all, 1,096 construction workers died of opioid overdoses in the five year span between 2011 and 2015.

While this study only covers Massachusetts, prescription opioids are a serious risk for all construction workers and any worker who is at risk for injury on the job. The progression from opioid use to dependence to abuse is real and well-documented.

A Toll Far Beyond Typical Workplace Fatalities

It’s difficult to understand the scope of 1,096 construction workers dying from opioid overdoses in Massachusetts between 2011 and 2015 without context. Unfortunately, here at the LHSFNA we often find it necessary to report about workplace fatalities. Analyzing this data can provide insight on safety initiatives that are working or warn of emerging trends when fatalities spike. Our experience analyzing workplace fatalities made the scope of the opioid problem in construction immediately apparent. For comparison, there were 69 construction workers killed on the job in Massachusetts between 2011-2015. That number includes workplace fatalities like falls, electrocutions and being struck by objects, among others. Compare that number to the 1,096 construction workers who died from opioids during the same timeframe. That means in a five year span, 16 times more workers died from opioids in Massachusetts than from all other causes of workplace deaths combined.

In the case of a pervasive problem like falls, contractors erect guardrails, cover floor openings and make use of personal fall arrest systems. To prevent trench collapses, contractors slope the excavation or use trench boxes as shielding to protect workers. Unfortunately, such tried-and-true solutions don’t yet exist to stop a complex opioid crisis that’s taking a drastic toll on construction workers and their families.

The Factors Contributing to Overdoses

There are many factors driving the opioid epidemic, and although some are currently outside the control of the construction industry, others can be directly affected by cooperation between labor and management. The MDPH report lists several reasons why construction workers are at such high risk for opioid abuse and overdose compared to other workers:

• Higher risk of work-related injury. Occupations with high rates of work-related injuries have higher rates of fatal opioid overdoses. For more on this topic, read our January article, “Preventing Opioid Addiction Starts with Preventing Pain.”
• A lack of paid sick time and job insecurity. Lacking paid sick time, construction workers could decide it’s better to use opioids and work through the pain than not showing up and risking their place on a project. A lack of paid sick time also makes it more difficult for workers recovering from addiction to get timely treatment.
• Availability of drugs on construction jobsites. Dr. Zev Schuman-Olivier of the Cambridge Health Alliance, who has many patients working in construction, says “It’s incredibly common for people to report that other people in their workplace have pills.” This can lead to prescription opioids being shared among workers without a doctor’s oversight. It can also create a difficult work environment for those in recovery, who see co-workers sharing pills and know that accessing them is easy.
• Stigma. The stigma surrounding addiction can make it difficult for workers to share that they have a problem and reach out for help. Sending the message that addiction is a chronic disease, not a moral failing or weakness, can help break this cycle and encourage people struggling with addiction to seek care and treatment.

Acknowledging, understanding and finding solutions for these factors will be critical to reducing opioid deaths in construction. Some of those solutions may be expensive or require people to step out of their comfort zone. But the alternative is much worse, because opioids are currently killing many more construction workers than jobsite hazards. If 1,096 workers in Massachusetts died from falls instead of opioids in five years, what level of resources, training and awareness would be committed to reversing that trend? We should treat the opioid problem in construction the same way.

[Nick Fox]