Gary Clevenger MS, CSP, CRIS, RRE, is the national risk control director, construction at CNA Insurance. As a safety and risk management professional with diverse experience, Clevenger has a background in risk management, training, self-directing work teams and understanding insurance coverage and regulatory compliance. Clevenger works closely with professional trade associations and CNA risk control professionals to develop risk management strategies, risk profiles, incident trending and predictive analytics for the construction industry. Visit cnainsurance.com.
Every day, 91 Americans die from an opioid overdose, according to the Centers for Disease Control and Prevention (CDC). The opioid abuse epidemic has taken a toll on many aspects of the United States economy, including construction businesses’ workers’ compensation losses.
According to the Center for Construction Research and Training, workers’ compensation costs for construction employees, per hour worked, are more than double the average cost for all other occupations. In addition, the National Institute for Occupational Safety and Health (NIOSH, a sister agency to the CDC) reports that narcotics—i.e., opioids—account for 29 percent of prescription costs in workers’ compensation.
When you think about it, the reasons aren’t far-fetched: Construction workers are constantly moving and handling materials in ways that can lead to strains, sprains, ligament tears and pulled muscles. In addition, the majority of construction workers are in their 40s or 50s, and although experienced, their bodies don’t heal quite like they used to. Injuries are painful and cause discomfort for an extended time.
Working in the construction industry already has its own challenges, particularly because it is a dynamic environment. Weather changes day to day, workers may be at heights or using heavy equipment, including hand tools or power tools. Their work environment is in flux because there are many activities occurring around which they have no control. On a commercial building, someone may be working on electrical wiring, another on drywall and someone else on plumbing, all within the same general area. If you add opioids to the mix, that creates a precarious situation.
Given their ages, construction workers often have families for which they are responsible. But if they don’t work, they don’t get paid. Even while injured, construction workers want to be on the job. You can see the appeal: If a medication—that’s socially acceptable because it was prescribed by a doctor—increases pain tolerance and allows a person to remain or come back to their jobs, why not take it?
However, what workers may fail to realize is that repeated opioid usage creates a cycle of abuse. When injured, a worker may change his or her gait or carry materials differently, leading to a second injury, or extend or overtax a previous injury. And now, instead of taking one pill, they take two. Research shows that if a worker has pain in three or more areas, they are more likely to become addicted to the opioid or painkiller.
Besides multiple injuries, other red flags can warn an employer if an employee is at risk of opioid addiction. According to a study from NIOSH, adults over 40 years of age are more likely to use prescription opioids than adults aged 20 to 39, and women are more likely to use opioids than men. Remember, the largest concentration of workers in construction is over the age of 40, and through strong education and marketing efforts by the industry, women continue to join the construction trades.
Preventing Opioid Addiction
Most prescription opioids are prescribed by primary care and internal medicine doctors and dentists, and rarely specialists. Therefore, don’t underestimate the role your medical provider network for workers’ compensation has in controlling opioid prescriptions and medical spend. Some networks can limit opioids refills or prohibit physicians—instead of pharmacists—from dispensing narcotics.
Your network also can ensure how prescription drugs are reduced, such as through the addition of hot and cold therapies, physical therapy and over-the-counter medications.
Second, ensure that your company practices sound manual material handling. Manual material handling is a main cause of strains and sprains for construction workers, but there are ways to mitigate its hazards using appropriate work practices. For example, instead of lifting a 60-pound bag of concrete from the ground, the bag should first be moved to waist level using pallets. The Occupational Safety and Health Administration (OSHA) and your workers’ comp insurance carrier will be able to suggest appropriate material handling, precautions and safety measures for construction workers.
What else can a construction employer do to thwart opioid abuse among its workers? These five prevention strategies can help:
- Educate employees about responsible prescription opioid use—Inform your workers about the potency of these drugs, how they work, any drug interactions and how they can become addictive.
- Understand risk factors surrounding opioid use, such as doctor shopping and physician dispensing.
- Provide support and a robust return-to-work program for injured employees—Your employee’s immediate supervisor can help prevent any further injury to the worker by refocusing his/ her injury away from disability and toward work ability, which improves morale. In addition, social support goes a long way when building a line of defense against drug and alcohol addictions.
- Communicate treatment options, including counseling and pharmaceutical treatment—Behavioral treatment can help an addict deal with cravings, avoid situations in which drugs are present and strengthen social support. Pharmacological interventions include the use of addiction medications as well as ongoing surveillance regarding prescriptions and usage patterns. A combined approach of behavioral and pharmacological yields greater success.
- Ask questions—The American College of Occupational and Environmental Medicine suggests that you ask the physicians in your medical provider network these sample questions:
- Are you using evidence-based treatment guidelines?
- Are you using principles of informed choice with your patients while advising them of the risk and benefits?
- Do you set expectations for discontinuation with limiting quintiles of opioids to treat acute pain?
- Are functional goals outlined at every visit?