Opioid use—and abuse—among construction workers has become the industry’s silent crisis. It frequently begins with pain, typically from jobsite-related injuries, including falls, or from tasks involving repetitive motion. Excessive exposure to vibration—in addition to bending, twisting and awkward postures—inflicts particularly hard wear and tear on backs, knees, shoulders and other joints.
And then the cycle of seeking relief for those ailments begins. Due to the ready availability of pain-relieving narcotics, the U.S. construction industry is trying to reverse a serious problem with opioid abuse among its workers and trades—a complex downward arc that results in further job injuries, shoddy craftsmanship, property damage, loss of productivity and profitability, even death.
Included in the loss column are the costs of recruiting and training replacements for chronic abusers, a problem compounded by the short supply of construction labor. There’s also the issue of attrition by overdose. In 2015, nearly 1,000 construction workers across seven Midwestern states suffered fatal opioid-related overdoses, according to estimates compiled by the St. Paul, Minn.-based Midwest Economic Policy Institute (MEPI) in its 2018 report, “Addressing the Opioid Epidemic Among Midwest Construction Workers.”
The construction industry isn’t alone in its battle against opioid abuse, of course. It’s a scourge that has afflicted millions of people since the late 1990s, when nonprofit The Joint Commission, which accredits more than 21,000 U.S. health-care organizations and programs, designated pain as the body’s “fifth vital sign.” Physicians rushed to prescribe narcotics such as oxycodone and hydrocodone.
Due to jobsite hazards and strenuous activity, however, pain disproportionately afflicts construction workers, making them more susceptible to substance abuse than “educators, professional office and administrative support workers,” says the Itasca, Ill.-based National Safety Council (NSC). Even when used properly, side effects of opioids can include sedation and dizziness—impairments not conducive to maintaining safe jobsites.
“Opioid abuse is one of the most critical issues we currently face as an industry,” says John Fish, CEO of Boston-based Suffolk Construction, a $3.3-billion general contractor that self-performs concrete, masonry, drywall and specialty construction, while also doing construction management for multiple building types.
“Part of the problem is that many workers aren’t properly trained to lift, stretch and execute their work,” says Fish. “It shouldn’t come as a surprise they seek painkillers, then return to work before they heal. If they don’t show up for work, they don't get paid.”
Jill Manzo, a researcher with MEPI and the author of its 2018 report, agrees. “Construction work is seasonal. The thinking is: take a pill and get back to work.” Rather than healing, workers continue to seek pain relief, she says.
Some physicians oblige, prescribing opioids for chronic pain over extended periods of time, even when their use, or prolonged use, isn’t warranted or isn’t the wisest course of action, says Dr. Joe Semkiu, medical director with Itasca, Ill.-based construction insurer Zurich North America.
“Take a strained rotator cuff,” says Semkiu. “Treatment for tissue disorders of that type calls for anti-inflammatories such as Advil, but instead we’ve seen physicians prescribing opioids.”
Because opioids are habit forming, particularly if consumed over prolonged periods of time, users may fall prey to addiction, requiring ever-larger doses to relieve pain. Some of them seek illegal drugs, including heroin, if they no longer can access prescriptions, Manzo says.
In response to this crisis, many contractors have begun to manage risk more aggressively, ranging from abuse-related educational programs to drug screening in support of workers’ efforts to seek rehabilitation.
“As a firm, we’ve worked to create a culture of trust, transparency and the understanding that there won’t be retribution against workers who have developed problems with opioids or other substances,” Fish says.
“Once a problem is identified, we assist in building a bridge between the worker and appropriate counseling and services. If recommended, we accommodate time off for the employee,” he says.
The firm screens job candidates for opioids and other substances as a condition for employment but does not perform random testing in the workplace. “We regard that as an invasion of the employee’s privacy,” Fish says.
By comparison, Torrington Conn.-based C.H. Nickerson and Co., a 125-employee general contractor that specializes in wastewater plants, counts itself among the first construction firms to perform random drug testing of trades. It initiated the policy in the 1990s to screen for heroin, cocaine and marijuana, among other substances. The firm since has expanded its screening to detect opioids. In the event that employees test positive, they can keep their jobs upon completion of a treatment program, says Connie Tynan, the firm’s director of human resources and compliance. In general, positive test rates among existing and incoming employees are low, in part because Nickerson is known for its drug-testing program, Tynan says.
In January, Colorado Springs-based GE Johnson Construction, a general contractor specializing in several building types, added opioids to its drug-screening program for all company employees. That includes 600 craftsmen—among them laborers, carpenters, iron workers and equipment operators.
The firm tests randomly and as a condition of employment, in addition to instances involving reasonable suspicion or a job-related injury. At present, employees who test positive for opioids are terminated, although GE Johnson President Jim Johnson says he has begun to rethink that policy. “Rather than fire employees, we’re evaluating options that would invest in their well-being,” he says.
The firm engaged in discussions to partner with Face It Together, an addiction consultant, to develop treatment plans that help employees in recovery and keep them working. If circumstances dictate time off, Johnson says he may be amenable to paid leave, as well as treatment programs for family members with addiction problems.
“The last thing we need is a crane operator preoccupied with the condition of his 18-year-old daughter,” Johnson says. Also being considered is termination if a worker refuses treatment or tests positive after a recovery program.
Industry organizations also are awakening to the issue of opioid abuse. The Associated General Contractors of America recently consulted with NSC and North America’s Building Trade Council (NABTU), Washington, D.C., about the problem, says Kevin Cannon, senior director of safety and health services at AGC.
In January, NABTU, a federation of 14 North American unions, established a task force to tackle opioid abuse. The group issued recommendations to “design out hazards that lead to pain on construction and overuse of opioids,” says Chris Cain, NABTU’s director of safety and health.
Another goal is educating trades that opioids may not be the appropriate course of treatment, given the availability of alternatives that include physical therapy and, when applicable, anti-inflammatory drugs. Initial efforts include determining the scope of the opioid problem among affiliated state and local trades and learning what, if any, actions they are taking, Cain says.
Evaluating the extent of the problem has proved problematic, although geographic hot spots for abuse include the Midwest, East and Southeast. A 2015 estimate by Chicago-based insurer CNA found that “15.1% of construction workers across various specializations have engaged in illicit drug use, including both legal and illegal [drugs].”
Significantly, CNA did not filter the estimate by specific drugs or trades, though it noted that opioids accounted for 20% of total spending on prescription drugs in the construction industry, about 5% to 10% greater than that of other industries. Another 2015 estimate by the Substance Abuse and Mental Health Administration indicated that 11.6% of full-time construction workers (1.1 million people) had used illicit drugs within the past month. Once again, all substances were grouped together, obscuring specific opioid usage and the trades most prone to it. Data released by NSC in 2017 does little to clarify matters, indicating that substance abuse among construction workers remained at 15%—as compared to the national average of 8.6%—but did not quantify usage by specific drug type or trade.
The picture is further clouded by the reluctance of construction firms to openly discuss their policies or experiences, sometimes on the advice of company attorneys. When ENR, for instance, contacted several leading contractors about the issue, the majority of them did not respond. “It’s the elephant in the room,” Fish says. “Lack of conversation contributes to an environment of endless pain. I think more discussion concerning wellness would help.”
Meanwhile, general and specialty contractors are partnering with insurers to develop safety programs and guidelines that minimize or eliminate site-related accidents. “The best way to avoid opioid abuse is to avoid accidents,” says Mike Mills, technical director, risk control, with Boston-based Liberty Mutual Insurance. A commitment to safety from top management and input from front-line workers are critical to developing successful safety programs, he says.
“Workers, such as backhoe operators or concrete block layers, are most familiar with pitfalls and methods to avoid them,” Mills says. Ideally, he adds, general contractors should take the lead, stipulating via contract that trades adhere to the contractor’s safety program and, if necessary, impose fines if they don’t. Components of the program may call for daily, supervisor-led, pre-task analyses that outline methods for performing the day’s work.
Assuming an accident occurs, workers’ compensation firms are trying to minimize overprescribing, using guidelines from the Centers for Disease Control, among others. CDC, for instance, specifies that physicians prescribe the lowest number of immediate-release opioids—rather than extended and time-release, long-acting variants—in doses no greater than the anticipated period of pain, typically three days, and no more than seven.
Like many insurers, Liberty Mutual tasks nurse case managers to serve as liaisons among physicians, injured workers, employers and insurance companies to ensure that overmedication doesn’t occur, says Matt Waters, chief underwriting officer, construction and energy, with Liberty Mutual. Other measures include utilization-review programs to determine whether a particular medical treatment is necessary, Semkiu says.
Those protocols have yielded positive results. Over a period of five years, Zurich North America says it has seen substantial decreases in morphine equivalents per day—a measurement to equate many different opioids into a single standard value. “Physicians are listening,” Semkiu says.
Likewise, the CDC indicated that U.S. opioid-prescription rates last year declined to their lowest point in a decade. Additionally, New York City-based clinical laboratory Quest Diagnostics reported a 17% decrease in positive test results for oxycodone, hydrocodone and hydromorphone, among other narcotics, between 2016 and 2017. However, only a small percentage of subjects tested—less than 20%—were screened for narcotics, says Barry Semple, Quest’s senior director of science and technology. The results were not classified by industry.
New policies also may be driving numbers down, says Kim Samano, scientific director with Quest Diagnostics. Nearly every U.S. state, for instance, has created a prescription drug-monitoring program to identify opioid users who visit several physicians and obtain multiple prescriptions or who fill the same prescription at different locations. In May, Colorado joined a growing number of states imposing limits on opioid prescriptions—in this instance, the first prescription and a refill—to seven days.
Semkiu lauds the trend: “It demonstrates the availability of alternative strategies and practices to manage pain.”