In 2018, the Massachusetts Department of Public Health reported that construction workers accounted for a quarter of opioid overdoses in the state. In a five year span, over 1000 workers lost their lives to opioids.

Around that same time, the Board of Trustees of the Massachusetts Laborers’ Health & Welfare Fund (MLBF), was seeing the real impact of the opioid crisis on LIUNA members – and knew it was time for a change. “We had to take an honest look at what we were doing, because it wasn’t working,” says Lou Mandarini, Executive Director of the MLBF. In 2011, the MLBF had stopped covering suboxone (also known as Buprenorphine/Naloxone) as the opioid epidemic was gaining steam. “We thought at the time if we didn’t cover suboxone, then people wouldn’t use it. We came to realize this was completely wrong.”

“We went to Locals across the state and asked how many people were taking suboxone. A lot of hands went up,” says Mandarini. “By not having a comprehensive medication-assisted treatment program, people had to choose between paying out of pocket or going to the street and taking their chances with something harder. It was like asking members if they wanted to be eaten by an alligator or a crocodile.”

Fortunately, the MLBF’s trustees were on board with a complete overhaul of how the fund addressed opioid addiction. The MLBF knew they wanted to build a complete, responsive program. That’s how they ended up with LEAN.

Launching the LEAN Program

LEAN, which stands for Laborers Escaping Addiction Now, is a comprehensive program offering peer-to-peer recovery support and referrals to multiple pathways to recovery, including but not limited to detox, intensive outpatient, 12 step, smart recovery, sober living and medication-assisted treatment (MAT). The LEAN program also provides extensive follow-up support to assist members on their path to long-term recovery, as well as support and referrals for family members struggling to cope with their loved one’s disease. After what they’d seen in the field, MLBF staff knew they had to do more than cover medications – they had to build a comprehensive program that could give members the attention they needed.

To design the program, the MLBF created a panel of addiction psychiatrists, public health officials from hospitals, pharmaceutical companies and other stakeholders. Those experts helped the MLBF create a program that would address multiple issues:

• Policy language. The program is clear that medication is to assist treatment, with requirements for both the prescriber and the member. Every aspect is spelled out, including how random drug testing works, the frequency of counseling sessions and even plans related to titration and handling cravings.
• Treatment availability. The LEAN program established a 24/7 hotline that would always be available for those seeking treatment or support. The MLBF then went a step further by examining geographical addiction hotspots in the region and working with treatment centers to guarantee that when a LIUNA member or family member was ready to seek treatment, there would be a place available.
• Filling in gaps and meeting needs. Understanding addiction and treatment at every step of the process made it clear to the MLBF that while an Employee Assistance Program (EAP) is a valuable resource, it was not sufficient on its own to meet the needs of LIUNA members and their families facing opioid addiction. For that, they created three new full-time positions within the MLBF.

Labor Recovery Specialists

Those struggling with addiction need a support system just as much as they need treatment. To provide that, the MLBF hired three Labor Recovery Specialists across the state. All three recovery specialists – Jonathan Ashwell, Mark Lyle and Glenn Troy – were Laborers in the field, had prior experience with addiction and were trained in peer recovery support.

“Between the three Labor Recovery Specialists, we have 42 years in the field and 29 year of sobriety,” says Jonathan Ashwell, a member of Local 999 who covers Central and Western Massachusetts, New Hampshire and Maine. “My job is to provide support as someone who really understands what these members and their families are going through. When I call a member who is struggling and they realize I’m a Laborer too, it goes a long way to establish credibility with that person.”

MLBF’s recovery specialists navigate members and their families through the program. That may include teaching family how to use Narcan, visiting members in recovery, attending a 12-step meeting or any number of other supports. The Health & Welfare Fund can identify those in need by monitoring use of the MAT system or substance use disorder claims. These members are then referred to an MLBF recovery specialist for outreach. Recovery specialists establish relationships by going to Local Union meetings, jobsites and training centers. Specialists also continually schedule on-site visits with clinical and administrative staff to ensure that network facilities are providing the best level of care for MLBF members.

“We’ll field a phone call at 7 a.m. from a foreman, a call at 11 p.m. from a member needing directions to a treatment facility or a call in the middle of the night when a person is ready to get treatment. We’re meeting the members where they are, and it’s all 100 percent confidential. Nothing we discuss goes anywhere else, not even to the Business Agent or Business Manager who means well and wants to check in on how a member is doing.”

Another part of the job of a labor recovery specialist is to reduce the stigma of addiction by letting members know that it is okay to ask for help. “As a Laborer, all you have is your name and your work ethic,” says Ashwell. “A lot of people don’t come forward because they’re afraid to taint one of those. Letting the member know that we’re in recovery too helps remove that stigma.”

Recovery specialists set up a peer-to-peer recovery group just for Laborers that meets weekly at Local 1421 in Tewksbury, MA. This group has been well-attended and there are plans to expand to locations around Massachusetts and Northern New England.

Results and Next Steps

Thus far, the response to and results of the program have been very encouraging. First, at the pharmacy level, the MLBF has seen a decrease in overprescribing. There are also plenty of firsthand success stories. Some patients transitioned to using suboxone in place of other opioids and maintained that dose, while others have tapered their dose or stopped using suboxone altogether. Because their quality of life is improved with the use of suboxone, patients are able to continue working without safety concerns and without the withdrawal symptoms that are often associated with being “dope sick.”

The real results are coming in the form of more and more members successfully making it through a treatment program and continuing to work for long-term recovery, Peer-to-peer support and access to multiple pathways to recovery allows members to transition back to daily life with a much lower risk for a deadly opioid overdose.

For more details about the LEAN program and how you can institute a similar program for LIUNA members and their families in your area, contact Lou Mandarini, Executive Director at the Massachusetts Laborers’ Benefit Funds by calling 781-272-1000.

[Nick Fox]