The construction industry is struggling with its biggest killer: drug overdose

At One Madison, a high-rise under construction on 23rd Street in Manhattan, workers face dangers every day: live wires, electrical hazards, heavy machinery. Cold gusts of wind whip around them as they pour concrete and operate forklifts. Access to the upper floors of the 28-story building is a ride on a noisy construction elevator.

City and federal officials recently visited the site to give a safety presentation, but they were not there to remind workers how to prevent falls or injuries. They showed employees how to prevent the industry's biggest killer: drug overdose.

“We're asking you to do things that will help you get home at the end of the day,” Brian Crain, a compliance assistance specialist with the Labor Department's Occupational Safety and Health Administration, told a crowd of more than a hundred employees wearing safety helmets. “Addiction works the same way,” he said.

Construction workers already had the highest death toll at work from any industry. They are now more likely to die from an overdose than those in any other field, according to a new analysis from the Centers for Disease Control and Prevention. Part of that disparity stems from workers being prescribed addictive medications to treat pain from injuries, which are common due to the physical nature of the job.

It's a problem that the industry – which has been trying to protect its workers from falls, electrocutions and chemical hazards – has struggled to get to grips with it for more than a decade. The presentation at One Madison in November was just one example of how the industry has come to deal with the problem in recent years. Unions now employ full-time addiction and mental health specialists, and workplace safety experts must increasingly focus on overdose prevention.

The industry has the highest death rate due to overdose the CDC study, which was published in August. The report, the agency's most comprehensive study 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 sector had the second highest rate with almost 118 deaths among the same number of workers.

But in the same year, the overall rate of on-the-job deaths in construction was about 10 workers per 100,000, according to Department of Labor data, suggesting that workers were roughly 16 times as likely to die from an overdose as from the effects of an overdose. a work-related injury.

“Statistically, this is a greater threat to the health and safety of construction workers than the actual work,” said Brian Turmail, a spokesman for the Associated General Contractors, a construction industry trade group.

The industry reflects a demographic vulnerable to addiction: a majority of construction workers are men, who are generally at greater risk than women of dying from an overdose. Spanish people are overrepresented in the construction sector and have a rising overdose death rate general.

The industry is often rife with episodic substance use, says Aaron Walsh, addiction recovery specialist at the St. Louis Laborers Health and Wellness Fund. Mr Walsh, who is recovering from drug addiction, is one of two people the union employs full-time to help members struggling with drug addiction.

“It's quite common in our population,” he said.

Injuries in construction are more common than in other sectors. The work is often stressful and taxing on workers' bodies, making them more susceptible to injury and more likely to seek medical attention for pain relief.

In many cases, workers carry heavy tool bags on their shoulders and spend long periods of time hunched over or on their knees. A third of the construction workers have muscle or bone disorders, which makes them three times more likely to be prescribed opioids for pain. They also don't often get paid sick leave, which can make opioids an option for a quick return to work.

Brendan Loftus knows that experience firsthand. In 1998 he fell into an elevator shaft at a construction site. He discovered he had a spinal cord injury while in the emergency room, but decided not to treat 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 to pay for a wedding,” Mr. Loftus said.

Construction work is often cyclical, which increases the pressure to work where possible. Once one project is completed, an employee may not know when the next project is coming. Wayne Russell, 32, a construction worker from New Jersey, has been out of work since November.

“Money can stop coming in, but your bills can't,” he said. Mr Russell spent some of his spare time taking a mental health and addictions course offered by his union, the International Union of Elevator Constructors. At a recent meeting, four of the ten men present, including Mr Russell, had struggled with substance abuse.

Mr. Loftus, who now provides addiction treatment to members of the International Union of Elevator Constructors, said his union began noticing that the overdose problem became 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 workplace fatalities, people would be protesting in the streets,” Mr Loftus said. “But no one wanted to talk about this because it was a dirty little secret.”

One of the first members to help Mr. Loftus recover was Michael Cruz, a 25-year-old construction worker who suffered from opioid addiction.

In October 2016, Mr. Cruz had just purchased construction supplies at Home Depot for an upcoming job when Mr. Loftus invited him to dinner. Mr. Cruz had recently completed a 30-day rehabilitation program and was eager to return to work. He was especially excited about the next project because it would be the first one he would be able to work on from start to finish.

Mr. Cruz declined the dinner invitation. Later that evening, he was found in his aunt's apartment in Queens, New York, dead of an apparent overdose, lying next to a bag containing the measuring tape and other supplies he had purchased that evening.

Mr. Loftus was the last person to speak to Mr. Cruz. “That's how it happens,” he said. “It's that fast.”

Through the whole country, overdose deaths are emerging. That's partly because many 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

Mr. Cruz's addiction began with painkillers prescribed to him after a car accident left him with persistent back pain. Eight years later, he had just earned his first paycheck after getting out of rehab when he died.

“He hid it well enough,” said his sister, Lizbeth Rodas, in her Morristown, N.J., home, which was decorated with framed family photos, including two of her brother. She described Mr. Cruz as both a joker and a gentleman who was like a brother to her children. “We thought he was cured and everything was back to normal.”

Ms. Rodas' husband and son both work in construction. Two years ago, when one of her sons was in a car accident, he was prescribed OxyContin for pain. Ms. Rodas said she begged him not to take it, and he complied.

“It was so scary for me to think that I would have to go through the same thing again,” she said.

Mr. Cruz's toxicology report showed traces of codeine, fentanyl and heroin in his system. Mr Loftus, the union adviser, said most workers addicted to substances such as heroin were first addicted to prescription painkillers. Of 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 Council on Compensation Insurance.

Part of the challenge the industry faces is breaking the stigma of addiction. Ms. Rodas said that when she and her family were preparing for Mr. Cruz's funeral, they were unsure whether to tell people that he died of an overdose. According to their mother's wishes, they chose to tell the truth.

“So many people came forward afterward,” she said, including union colleagues.

Tackling such a widespread problem is a herculean task for industry safety leaders, who are accustomed to protecting workers from physical harm. Construction companies are increasingly supplying job sites with Narcan, a brand name for the opioid overdose drug naloxone.

“It's not just about the physical safety of workers on our construction sites, it's also about what happens when they're not on the job site,” said Rebecca Severson, director of safety at Gilbane Building Company, one of many that have started Narcan to add to his first aid kits.

The Center for Construction Research and Training, a nonprofit organization founded by a federation of construction unions, has sponsored research projects on the effectiveness of various mitigation measures, including having Narcan on construction 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 in chemical exposure, which is critical in an industry where workers may often handle materials containing asbestos and lead.

Ms. Cain initially did not see overdose prevention as a particularly integral part of her job. Now it is the most acute safety problem in her field. Since 2018, she has led the group's response to the overdose crisis plaguing the construction industry.

“As I prepared to create this task force, I cried,” Ms. Cain said. “It's really outside my area of ​​expertise.”

Audio produced by Patricia Sulbarán.