Construction workers carry building materials in Stamford, Connecticut, in 2023. Construction work sometimes comes with pain, fueling an opioid overdose epidemic in the industry.
Photo by John Moore, courtesy Getty Images
“There’s a lot of pain in construction, and we know that pain is being under-reported.”
— Ann Marie Dale
People who work in construction get hurt on the job more often than other U.S. workers. Beyond the physical strain, they have the nation’s highest occupational rates for falls, slips and trips. The often-painful aftermath puts them at risk for another deadly hazard: opioid misuse.
The decades-long opioid crisis that started with the proliferation of prescription painkillers has hit the construction sector especially hard. Among occupations, no workforce category has a higher rate of fatal drug overdose — or even comes close.
“The rates remain stubbornly high,” said Kevin Cannon, senior director for safety, health and risk management at the Associated General Contractors of America. “And the pandemic did not help.”
The latest data from the Centers for Disease Control and Prevention, released last year, show more than 162 drug overdose deaths per 100,000 construction workers in 2020. The next highest rate by occupation was among food preparation and service workers, at almost 118 overdose deaths per 100,000 workers. Synthetic opioids, such as fentanyl, were involved in most overdose deaths for all occupations.
White men — who make up most of the construction workforce, including laborers, management and engineers — accounted for the majority of overdose deaths in the building sector. Particularly high overall rates are seen in the U.S. Midwest and Northeast.
The problem is not a recent one. Overdose deaths within construction have been rising for years, increasing nine times between 2011 and 2018, according to CDC. In many places, stakeholders across the construction industry— including employers, unions, workers and health and safety advocates — have been partnering to respond. But the problem is as hard to budge as the national overdose epidemic, which killed a record 108,000 Americans in 2022.
“We still have a problem,” said Chris Cain, executive director of CPWR — the Center for Construction Research and Training, a nonprofit affiliated with North America’s Building Trades Unions. “These numbers are not getting any better.”
People work at a New York City construction site last year. Construction workers are often given opioids for their work-related pain, upping risks for addiction.
Photo by Spencer Platt, courtesy Getty Images
Prevention efforts within the construction sector face challenges similar to the larger, national epidemic, such as overprescribing of opioids and stigma associated with addiction. But construction workers also face unique risk factors, such as disproportionately high rates of musculoskeletal injuries.
“There’s a lot of pain in construction, and we know that pain is being under-reported,” Ann Marie Dale, PhD, a researcher at the Healthier Workforce Center of the Midwest, told The Nation’s Health.
In a study published in 2021 in the American Journal of Industrial Medicine, Dale and co-authors examined union health claims from nearly 20,000 construction workers between 2015 and 2018. They found that workers receiving opioids for chronic musculoskeletal conditions had the highest odds of developing an opioid use disorder. Those being prescribed opioids long term were nearly 10 times as likely to develop a disorder.
In addition to the physical risk and strain of construction, many workers in the sector also lack job security and paid leave, which Dale said can exacerbate the risk of opioid misuse and restrict the ability of workers to seek out nonopioid pain therapies. In 2019, just 56% of workers in construction, extraction, farming, fishing and forestry had access to paid sick leave, according to federal labor statistics.
“In construction, if you don’t go to work, you don’t get paid,” said Dale, also a professor of medicine and occupational therapy at Washington University in St. Louis. “So popping a pill seems like a good solution… These are people just trying to work.”
A patchwork of response efforts are underway — some for many years — including worksite education about opioid risks, union-led referral programs for workers seeking drug use treatment, and injury prevention efforts aimed at apprentices. In New England, for example, the Massachusetts Coalition for Occupational Safety and Health partnered with Teamsters Local 25 to train shop stewards as peer advocates who can identify co-workers struggling with substance use and connect them to help.
New data from the Massachusetts Department of Public Health show such efforts are badly needed. In May, the agency released a report that links — for the first time — work-related injuries in the state to opioid overdose fatalities. It found that working-age people who died between 2011 and 2020 were 35% more likely to have died of an opioid overdose if they were injured at work.
Injured workers who died from an opioid overdose were more likely to work in construction and extraction, the data showed.
The construction industry has the nation’s highest injury rates.
Photo by Sarawut Khawngoen, courtesy iStockphoto
Elissa Cadillic, MEd, president of the MassCOSH board of directors, said the coalition has also integrated opioid education at its Immigrant Worker Center, which serves a population especially vulnerable to workplace injuries and often with little access to health care.
“A lot of this work is about empowerment,” Cadillic said.
Barriers such as low wages and lax enforcement of occupational safety laws also make it challenging to reverse job-related overdose trends.
Frank Callahan, president of the Massachusetts Building Trades Union, said even in his state, with relatively good unemployment and workers’ compensation systems, the financial need to find ways to labor through the pain can be overwhelming.
“Workers’ comp only makes up about two-thirds of what you can make at work,” he said. “So there’s an incentive to keep working.”
The union Callahan leads — which represents more than 75,000 workers — conducts outreach on drug misuse and overdose prevention. One example is sending people from recovery programs to speak with construction workers during “safety stand-downs.” Another is distributing naloxone, a drug that can reverse an opioid overdose, directly to construction sites.
“We call each other brothers and sisters in the building trades,” Callahan told The Nation’s Health. “We don’t want to lose you.”
Such prevention is even more urgent in the context of troubling suicide data.
In 2023, a study from CDC found construction has one of the highest suicide rates among all jobs, with men in the profession dying by suicide at twice the rate of the average American worker. Another study, published in 2023 in the Archives of Suicide Research, found that 1 in 5 working-age men in Utah who died by suicide between 2005-2015 worked in construction and extraction.
A quarter of those Utah construction workers who died by suicide in 2014-2015 tested positive for opioids, according to the research.
Cannon, of the Associated General Contractors of America, said suicide prevention has moved to the forefront of the organization’s mental health and substance abuse efforts.
“You can’t have a discussion about one without having a discussion about the other,” he said about overdose and suicide in the sector.
Ultimately, cooperative efforts must prioritize on-the-job safety, Dale said, as construction workers with job-related injuries are much more likely to use opioids than workers without injuries.
“When I say industry has to come together, this is what I mean,” she said. “There are ways to change how work is done to prevent workers from getting hurt.”
For more information, visit www.cpwr.com or https://hwc.public-health.uiowa.edu.
- Copyright The Nation’s Health, American Public Health Association
