The industry is rethinking its approach to safety because its workers are more likely to die from overdoses than those in other occupations.
At One Madison, a skyscraper under construction on 23rd Street in Manhattan, workers face dangers every day: live wires, electrical hazards, heavy machinery. Gusts of cold wind surround them as they pour concrete and operate forklifts. Access to the upper floors of the 28-story building is a ride in a noisy construction elevator.
Recently, city and federal officials visited the job site to give a safety presentation, but they weren’t there to remind workers how to avoid falls or injuries. They were showing how to prevent the biggest cause of death in the industry: drug overdose.
“We ask them to do things with an eye toward going home at the end of the day,” Brian Crain, a compliance assistance specialist with the Department of Labor’s Occupational Safety and Health Administration, told a group of more than 100 workers wearing hard hats. of security. “Addiction works the same way,” he said.
Construction workers already had the highest number of on-the-job deaths of any industry. Now, they are more likely to die from overdoses than those in any other line of work, according to a new analysis from the U.S. Centers for Disease Control and Prevention. That disparity is partly due to addictive medication. It is prescribed to workers to manage pain from injuries, which are common due to the physical nature of the work.
It’s a problem that the industry — which is already trying to protect its workers from falls, electrocutions and chemical hazards — has been trying to solve for more than a decade. The presentation at One Madison in November is just one example of how the industry has begun to confront the issue in recent years. Unions now employ addiction and mental health specialists full-time, and workplace safety experts have increasingly had to focus on preventing overdoses.
The industry has the highest death rate attributed to overdoses, according to the CDC study released in August. The report, the agency’s most comprehensive examination of overdose deaths by occupation, found that there were more than 162 overdose deaths per 100,000 construction workers in 2020, the most recent year for which data is available. The food service industry, with nearly 118 deaths among the same number of workers, had the second highest rate.
But in the same year, the number of total on-the-job deaths in construction was about 10 employees per 100,000, according to Department of Labor data, implying that workers were about 16 times more likely to die from an overdose than from an injury related to their occupation.
“Statistically, this is a greater threat to the health and safety of construction workers than the job itself,” said Brian Turmail, spokesman for Associated General Contractors, a construction industry trade group.
Vulnerable demographics
The industry reflects demographics vulnerable to addiction: Most construction workers are men, who are generally more likely than women to die from overdoses. Hispanic people are overrepresented in the construction industry and generally have a rising overdose death rate.
Casual substance use is generally widespread in the industry, said Aaron Walsh, an addiction recovery specialist with the St. Louis Workers’ Health and Welfare Fund. Walsh, who is in recovery from drug addiction, is one of two people the union employs full time to help members struggling with drug addiction.
“It’s quite prevalent in our population,” he said.
Injuries in construction are more common than in other fields. The work is often stressful and heavy on workers’ bodies, making them susceptible to injury and more likely to seek medical attention for pain relief.
In many cases, workers carry heavy tool bags and spend prolonged periods bending or kneeling. One-third of construction workers have muscle or bone ailments, making them three times more likely to be prescribed opioids for pain. They also typically do not receive paid sick leave, which could make opioids an option for returning to work quickly.
Brendan Loftus knows that experience firsthand. In 1998, he fell down an elevator shaft at a construction site. He learned that he had a spinal injury while in the emergency room, but decided not to manage his pain with opioids because he had already overcome an opioid addiction. He was getting married in a month, so, against medical advice, he returned to work after just two weeks. “I had a wedding to pay for,” Loftus said.
Construction work tends to be cyclical, which increases the pressure to work whenever possible. Once a project is finished, a worker may not know when the next one will come. Wayne Russell, a 32-year-old construction worker from New Jersey, has been out of work since November.
“The money may stop coming, but your bills may not,” he said. Russell spent some of his free time taking a mental health and addiction course offered by his union, the International Union of Elevator Builders. At a recent meeting, four of the 10 men present, including Russell, had struggled with substance abuse.
Loftus, who now provides addiction services for members of the International Union of Elevator Builders, said his union had begun to notice the overdose problem was becoming serious in 2015, when it lost five members to overdoses in 11 months, and that the problem had only gotten worse.
“If we had lost five members to on-the-job fatalities, people would be protesting in the streets,” Loftus said. “But no one wanted to talk about this, because it was a dirty secret.”
One of the first members Loftus helped with recovery was Michael Cruz, a 25-year-old construction worker who had an opioid addiction.
In October 2016, Cruz had just purchased construction materials at Home Depot for an upcoming job when Loftus invited him to dinner. Cruz had recently come out of a 30-day rehab program and was eager to get back to work. He was particularly excited about his next project, as it would be the first one he could work on from start to finish.
Cruz declined the invitation to dinner. Later that same night, he was found in his aunt’s apartment in Queens, New York, dead of an apparent overdose, his body lying next to a bag with a tape measure and other supplies he had taken. bought that afternoon.
Loftus was the last person to speak with Cruz. “That’s how it happens,” he said. “It’s that fast.”
Across the United States, overdose deaths are on the rise. That’s partly because many of those addicted to prescription painkillers may turn to street drugs like fentanyl and other powerful synthetic opioids, which health officials say are often mixed with other stimulants. The pharmaceutical industry has been widely accused of profiting from the country’s opioid crisis, which killed nearly 645,000 people between 1999 and 2021, according to the CDC.
Cruz’s addiction began with painkillers he had been prescribed after a car accident that left him with persistent pain in his back. Eight years later, she had just received her first paycheck from him after leaving rehab when he died.
“He hid it very well,” said his sister, Lizbeth Rodas, in their home in Morristown, New Jersey, decorated with framed family photos, including two of her brother. She described Cruz as a joker and a gentleman who was like a brother to her children. “We thought he was cured and everything was back to normal.”
Rodas’ husband and son work in construction. Two years ago, when one of her sons was in a car accident, he was prescribed OxyContin for pain. Rodas said he had begged him not to take it, and he complied.
“It was so scary for me, thinking about going through the same thing again,” she said.
Cruz’s toxicology report showed traces of codeine, fentanyl and heroin in his system. Loftus, the union counselor, said most workers addicted to substances like heroin had first become addicted to prescription painkillers. Among workers’ compensation claims with at least one prescription, about a quarter had one for an opioid, according to data from 40 states collected by the National Compensation Insurance Council.
Part of the challenge facing the industry is breaking the stigma of addiction. Rodas said that when she and her family were preparing for Cruz’s funeral, they weren’t sure if they should tell people that she died of an overdose. Because of her mother’s wishes, they chose to tell the truth.
“So many people came forward after that,” she said, including union colleagues.
gigantic task
Addressing such a widespread problem is a mammoth task for industry safety leaders, who are accustomed to protecting workers from physical injury. Increasingly, construction companies are equipping job sites with Narcan, the brand name for naloxone, the opioid overdose reversal medication.
“It’s not just about the physical safety of workers on our job sites, but also what happens when they’re not on the construction site,” said Rebecca Severson, director of safety at construction company Gilbane, one of the many who have begun adding Narcan to their first aid kits.
The Construction Research and Training Center, a nonprofit organization created by a federation of construction unions, has sponsored research projects on the effectiveness of various mitigation measures, including having Narcan on job sites and offering workers paid sick leave.
Chris Trahan Cain, the center’s executive director, has decades of experience making construction jobs safer. She is an expert on chemical exposure, which is a vital concern in an industry where workers often handle materials containing asbestos and lead.
Cain initially didn’t see overdose prevention as a particularly integral part of his job. Now, it is the most acute security problem in his field. Since 2018, he has led the group’s response to the overdose crisis plaguing the construction industry.
“As I prepared to create this task force, I cried,” Cain said. “It really is beyond the scope of my experience.”
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