Between 2011 and 2018, unintentional drug overdose deaths in the construction industry increased by a factor of 9.3, according to the Center for Construction Research and Training (CPWR), compared with a 4.2 increase for all industries.
[Related: NAHB rolls out opioid education resources]
Nearly half of those fatalities are caused by nonmedical drug use, Sue Dong, director of CPWR’s Data Center, said on a webinar in February.
The report found that the number of workplace overdose fatalities was more than twice as high in residential building construction than nonresidential construction.
“We know many self-employed workers are working in residential construction,” Dong said. The report also found workplace overdose fatalities were disproportionately higher among those self-employed workers, 28.5% of whom die from overdoses, compared to 18% of self-employed workers who die from other causes.
One-quarter of construction workers who are injured at work are prescription opioid users. They tend to be older and white, and they’re more likely to have health insurance.
Dong believes older workers are more likely to have chronic conditions like muscular skeletal disorders, leading them to use these types of medications.
Using data from the Medical Expenditure Panel Survey, CPWR found that despite the disproportionately high rate of overdose fatalities in the industry, construction workers are prescribed opioids at a lower rate than workers in all industries.
“We don’t know exactly what causes this,” Chris Cain, executive director of CPWR, said on the webinar. “We have some theories, but we don’t necessarily know for sure.”
Illicit drug use
“Construction workers had the highest rate of illicit drug use in their lifetime—about 30% higher than all industries combined. Why? We know construction workers are much less likely to receive insurance through their employers, and a construction job is not secured,” Dong said.
Marijuana was the most common of those drugs, especially among younger workers, who were more likely to consume pot as well as any illicit drug. CPWR did not include data for states where marijuana has been legalized to some extent.
Non-Hispanic workers were much more likely to use illicit drugs, ranging between 14.4% and 17.1% of workers. Just 6.7% of Hispanic workers used illicit drugs, CPWR found.
“We can’t talk about opioids in construction without acknowledging that … construction workers are 30% more likely to self-report illicit drug use,” Cain said. “Bearing in mind that a 30% increase in this population in no way explains [why] workers in our industry are dying at six to seven times the rate for other workers. That math simply doesn’t add up.”
Preventing injuries that cause pain should be the first priority in reducing the rate of construction fatalities due to overdoses, CPWR suggested.
It’s naïve to think that injuries can fall to zero across the industry, so CPWR recommends increasing education on effective treatments for injuries that don’t involve opioids, and substance use disorder treatment, as secondary and tertiary approaches.
Cain believes having paid time off could reduce the number of people who turn to opioids for pain management, but she noted data to support that theory is anecdotal.
“Construction workers can’t take a sick day in many cases,” Cain said. “How much does that contribute to this epidemic, that a construction worker may instead go to their doctor and be put on pain medication so that they can continue to work through the pain?”
Naloxone, or Narcan, is an FDA-approved drug that counteracts the symptoms of an overdose. Colorado is among the 43 states where nonmedical personnel are authorized to issue naloxone, according to the Prescription Drug Abuse Policy System.
NIOSH has a factsheet about using naloxone to reverse opioid overdoses in the workplace, including a checklist with guidance on what to consider before implementing a workplace naloxone program.