Construction firms struggle with opioids

The wear and tear construction work inflicts on the human body makes the industry a ground zero for the opioid epidemic, experts say.

High injury rates, decades of loose prescribing of opioids to workers suffering from chronic pain, lack of sick pay and the cyclical nature of construction work combine to create an environment where workers are more likely to be exposed to addictive drugs, they say.

While drug testing can help identify impaired workers, it won’t solve what has become a systemic problem for the sector, they say.

“We have to face it: Injuries are happening on our job sites, and this is something that has become a byproduct of all of that,” said Robert Petrucelli, Wellesley, Massachusetts-based CEO of the Associated General Contractors of Massachusetts. “They are getting injured on the job, and they are getting prescribed pain medications.”

The problem is two-pronged and affects work sites differently, he said. First, workers come to work after taking medication not intended to be used while on the job, creating safety concerns. Second, workers are becoming addicted to pain medication.

“We know that people in construction have high-impact jobs,” said Rachael Cooper, senior program manager for opioid use harm prevention at the Itasca, Illinois-based National Safety Council. Construction workers also tend to experience injuries more frequently, often have a lack of sick time and, given the short-term nature of many construction contracts, want to get back to work quickly, she said.

Death rates are a growing concern, which Mr. Petrucelli called “sobering.” For example, between 2011 and 2015, 25% of people who died from opioid overdoses in Massachusetts were construction workers, according to data released last year by the Massachusetts Department of Public Health, which also found construction workers six times more likely than other workers to overdose on strong pain medications.

The problem is a nationwide issue among ironworkers, carpenters, roofers and others whose jobs are to build, doing tasks that break down muscles and bone, said Chris Cain, executive director of The Center for Construction Research and Training in Silver Spring, Maryland.

“It’s not, ‘Oh, construction workers have pill problems,’ it’s about work that causes pain,” she said.

The problem has no easy answer, according to experts who say construction workers are among the least likely to skip work as a result of pain.

“It’s strenuous work, and you only get paid for hours worked,” said Thomas Gunning, director of labor relations for the Building Trades Employers Association in Braintree, Massachusetts. “If you can, take a pill and go to work,” he said.

A painful industry

While injury rates in the construction industry overall mirror those of all industries, standing at 3.1 recordable injuries for every 100 workers, certain segments of the construction sector have injury rates that tower over those figures, according to the latest Bureau of Labor Statistics data released for 2017. New data will be released in December.

For example, 7.5 framing contractors were injured for every 100, and the injury rate stood at 4.9 for structural steel and precast concrete contractors and at 4.3 for foundation, structure and building exterior contractors, according to the data.

The incident rates don’t always take into account one of the biggest drivers of pain among construction workers: chronic pain from soft-tissue injuries accumulated over years working in the industry, according to Ms. Cain.

“Fifty percent of construction workers live in pain,” she estimated. “When you have an industry that inflicts so much pain on the worker, there is a normal human reaction to try to deal with that pain.”

As a result, opioid use tends to be higher in the construction industry, according to Melissa Burke, Southington, Connecticut-based head of managed care and clinical for comp insurer AmTrust Financial Services Inc.

“I think it relates to the severity of the injuries,” she said. “In construction, (injuries) tend to be high-severity, and also workers want to come back to work as fast as possible. There’s high pressure to get back to the job.”

No work, no pay

Construction work is cyclical — often taking place in the warmer months — and relies on contracts, deadlines and some out-of-town jobs, which makes the situation for a worker hampered by pain complicated, according to Ms. Cain, because workers feel they have to work whenever they can, regardless of pain.

“Construction workers don’t get sick time, and if they don’t work, they don’t get paid,” said Ms. Cain. “You are going to take your 16-hour days and you are going to work your tail off. What happens if you are in pain? You go to your doctor.”

Pain medications taken by construction workers aren’t always obtained through the workers compensation system; some come from primary care physicians on the group health side, according to experts, who say such a visit would trigger a comp claim and time off if necessary.

“It’s up to the individual whether he is going to take off work or not,” said Mr. Gunning, whose own experience tells him that the pay cut that comes with comp — two-thirds of pay equals indemnity in most states — is a deterrent to reporting pain or treatment on the job site. Instead, it’s kept a secret, he said, adding that a doctor could allow a person to return to work despite having a prescription.

“Then there is this construction tough-guy mentality,” he said. “You get up and you work every day.”

The St. Paul, Minnesota-based Midwest Economic Policy Institute in 2018 found the injury rate for construction workers in several Midwest states studied to be 77% higher than the national average for other occupations. As a result, an estimated 15% of the region’s construction workers have a substance abuse disorder, compared with the national average of 8.6%.

“In the construction business, if you don’t go to work you don’t get paid, and that’s the beginning and end of it,” said David Argus, director of operations for Karas & Karas Glass Co. Inc. in South Boston, Massachusetts, who also does volunteer work with former addicts in construction.

Mr. Argus, in his work as president of the newly formed nonprofit The Boston Phoenix Foundation, said he learned more about the problem by spending time with the workers themselves.

“People say they had to go to work, through their injuries and soreness, and everybody was saying that (taking opioids) was a great way to work and not deal with pain,” he said. “And the pills were everywhere.” 

Impairment struggles

The limits of drug tests to determine drug use coupled with the ever-present legal obstacle of someone working while testing positive for a drug that was legally prescribed to them, a component of the federal Americans with Disabilities Act that protects workers with medical conditions, along with the transitory nature of construction sites and changing crews, makes spotting impairment tough, according to experts.

“It’s harder to spot (an impairment) if it’s not an employee that you work with consistently,” said Ms. Burke, adding that supervisors and employees may not know where to turn for help on a construction site or know what resources are available.

“If you’re not continuously in the same place … drugs in the workplace, drug impairment, testing, it’s harder to enforce,” she said.

Ms. Cain said drug testing will always be a part of contracts in construction, but “these people are not always impaired and they are able to work,” she said. “A lot of them are on a legal prescription.”

The issue raises other questions about better care for employees, according to Ms. Cooper.

Employers “need to be proactive … how do we link people into the care they need?” said Ms. Cooper. “They really need to develop policies and train supervisors to recognize impairment.”