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Understanding the factors underlying substance misuse & how employers can address it
by Cal Beyer

The Centers for Disease Control and Prevention (CDC) reports the number of overdose deaths in the U.S. has more than doubled in the past five years. Over 105,000 Americans died from all overdoses in calendar year 2022, and approximately 70% of all overdose deaths in the U.S. are attributed to opioids. Almost 70% of all opioid deaths are due to synthetics, especially fentanyl.

For more than two decades, the U.S. has felt the impact of this epidemic. Overdose deaths inflict a toll on families, workplaces, communities and the national economy. The opioid crisis impacts every socioeconomic class and demographic in the country. Every year, a portion of working-aged adults and youth is lost to overdoses. Nationally, the age group most affected by overdoses is those aged between 25-34 years. Males account for 71% and females comprise 29% of all overdose deaths.

A recent CDC report confirmed the construction and extraction industries have been hit hard by the opioid crisis. The report, released on Aug. 22, 2023, is titled “Drug Overdose Mortality by Usual Occupation and Industry: 46 U.S. States and New York City, 2020.” The construction and extraction industries had the highest rate of overdose deaths in 2020, the first year of the pandemic.

This is the first time there has been national data highlighting the impact of the opioid on industry groups and occupations. The rate per 100,000 workers was reported as 162.6 per 100,000 workers. Isolating the construction industry from the extraction industry, the rate falls to a lower level of 130.9 per 100,000 workers. This number is almost three times higher than the rate of suicide for the construction industry reported as 45.3 per 100,000 workers.


Musculoskeletal Injuries Contribute to Opioid Use in Construction

A major contributing factor for opioids in construction stems from the high frequency of musculoskeletal injuries affecting construction workers. The Center for Construction Research and Training (CPWR) highlights approximately 34% of construction workers have at least one musculoskeletal disorder — which can lead to opioid prescriptions.

Despite opioid prescriptions declining for 13 consecutive years, prescription medications for on- and off-the-job injuries continue to be source of new persistent opioid use in construction. “In Waging a Counterattack Against Opioids in the Workplace & at Home,” the increased frequency of opioid prescriptions among construction workers is highlighted. Moreover, prescription doses tend to be 20% stronger and for 20% longer durations.


Action Steps for Construction Leaders

There is a need for urgent and focused action to address the impact of opioids and other substances leading to overdoses.

1. Initiate a discussion among the company’s leadership team to intentionally break down stigma associated with substance misuse and substance use disorders.

Discuss the operational and financial toll substance misuse has on the company and its workforce. The National Safety Council’s employer substance use cost calculator is an effective tool at quickly looking at the effects substance misuse has to the company and on the workforce. 


2. National nonprofit SAFE Project (Stop the Addiction Fatality Epidemic) uses the No Shame Pledge form as a means of breaking stigma associated with substance misuse.

Company leaders are increasingly signing and posting the No Shame Pledge at company locations and on social media to encourage employees to seek support for themselves and family members.

  • To take the online SAFE Project No Shame Pledge click here.
  • To download the SAFE Project No Shame Toolkit, click here.


3. Identify resources and services available to employees and family members seeking support for substance misuse addiction treatment and recovery.

This includes understanding the resources and services available from a company- or union-sponsored employee health benefits programs, including the employee assistance program (EAP).

An increasing number of companies are sharing information about recovery programs, including 12-step programs, like Alcoholics Anonymous and Narcotics Anonymous. SMART Recovery is another option, which stands for Self-Management and Recovery Training.

The US Substance Abuse Mental Health Service Administration (SAMHSA) operates a National Helpline. Calling 800-662-HELP (4357) is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.


4. Review Worker’s Compensation injury reports to identify operations and work practices with high potential for musculoskeletal injuries.


Double-down on injury prevention to reduce the frequency and severity of soft tissue sprain and strain injuries.


5. Provide basic education on opioids in toolbox talks or in conjunction with daily safety huddles on risks of opioids.

Teach employees about the availability of alternative non-opioid pain management medications. Reinforce the importance of everyone becoming an advocate for themselves and their family members scheduled for any medical, surgical or dental procedures to minimize unnecessary exposure to opioids.

The Center for Construction Research and Training (CPWR) has compiled various resources that can help with developing supervisory and employee education:  One such resource is the “Workplace Guidelines to Prevent Opioid and Substance Abuse for the Construction Trades,” which  provides an understanding of how opioids and substance misuse impact construction.


6. Consider distributing at-home drug deactivation and disposal products to employees in conjunction with an education program on opioid risks.


Drug deactivation products help properly dispose of leftover opioid pills after prescriptions for on- and off-the-job injuries and surgeries. Research shows 90% of patients receiving pain medication do not properly dispose of the leftover pills. This increases the household risk of overdose deaths due to the diversion of the leftover pills.


7. Consider the benefits of stocking naloxone (Narcan) in your workplace and projects/jobsites.

The US Food and Drug Administration (DFA) approved two naloxone products in 2023 for over-the-counter use: Narcan on March 29 and RiVive on Aug. 3. It is important to understand the Good Samaritan and naloxone access laws that exist in the state in which you are considering stocking naloxone. The Legislative Policy Analysis and Public Policy Association (LAPPA) and SAFE Project have compiled updates for both these topics: