At One Madison, a high-rise under construction on 23rd Street in Manhattan, workers face dangers daily: live wires, electrical hazards, heavy machinery. Cold gusts of wind whip around them as they lay 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 visited the site recently to give a safety presentation, but they weren’t there to remind workers how to avoid falls or injuries. They were showing workers how to prevent the biggest killer in the industry: a drug overdose.
“We ask you to do things based on getting home at the end of the day,” Brian Crain, a compliance assistance specialist at the Labor Department’s Occupational Safety and Health Administration, told a crowd of more than 100 workers in hard hats. “Addiction works the same way,” he said.
Construction workers already had the highest on-the-job death toll of any industry. Now they are more likely to die of overdose than those in any other line of work, according to a new analysis by the Centers for Disease Control and Prevention. That disparity stems in part from addictive medication workers are prescribed to manage pain from injuries, which are common because of the physical nature of the work.
It’s an issue that the industry — which is already trying to protect its workers from falls, electrocutions and chemical hazards — has struggled to get a handle on for more than a decade. The presentation at One Madison in November was just one example of how the industry has started reckoning with the problem in recent years. Unions now employ full-time addiction and mental health specialists, and workplace safety experts have increasingly had to focus on preventing overdoses.
The industry has the highest death rate attributed to overdose, according to the CDC study, which was published in August. The report, the agency’s most comprehensive examination 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 service industry, with nearly 118 deaths among the same number of workers, had the second-highest rate.
But in the same year, the number of overall deaths on the job in construction was about 10 workers per 100,000, according to data from the Department of Labor, suggesting that workers were roughly 16 times as likely to die of an overdose as they were from a work-related injury.
“Statistically, this is a bigger threat to construction workers’ health and safety than the actual work,” said Brian Turmail, a spokesperson at the Associated General Contractors, a construction industry trade group.
The industry mirrors demographics vulnerable to addiction: A majority of construction workers are men, who are more likely than women to die of overdoses overall. Hispanic people are overrepresented in the construction industry and have a rising overdose mortality rate overall.
The industry is often rife with casual substance use, said Aaron Walsh, an addiction recovery specialist with the St. Louis Laborers’ health and welfare fund. Walsh, who is in recovery for drug addiction, is one of two people the union employs full time to help members struggling with drug addiction.
“It’s pretty prevalent in our population,” he said.
Injuries in construction are more common than in other fields. The job is often stressful and hard on workers’ bodies, making them 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 bent down or on their knees. One-third of construction workers have muscle or bone ailments, which make them three times as likely to be prescribed opioids for pain. They also do not often get paid sick leave, which could make opioids an option for getting back to work quickly.
Brendan Loftus knows that experience firsthand. In 1998, he fell down an elevator shaft at a construction site. He learned that he had a spinal injury while in the emergency room but decided to not manage 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 only two weeks. “I had a wedding to pay for,” Loftus said.
Construction work tends to be cyclical, adding to the pressure to work whenever possible. Once one project is done, a worker may not know when the next one will come. Wayne Russell, 32, a construction worker from New Jersey, has been out of work since November.
“Money can stop coming in, but your bills don’t,” he said. Russell spent some of his time off taking a mental health and addiction course offered by his union, the International Union of Elevator Constructors. At a recent meeting, four of the 10 men in attendance, including Russell, had struggled with substance abuse.
Loftus, who now provides addiction services for members of the International Union of Elevator Constructors, said that his union had begun to notice that the overdose problem was getting severe in 2015 when it lost five members to overdoses in 11 months, and that the problem had gotten only worse.
“If we had lost five members to on-the-job fatalities, people would be picketing in the streets,” Loftus said. “But nobody wanted to talk about this, because it was a dirty little secret.”
One of the first members Loftus helped with recovery was Michael Cruz, a 25-year-old construction worker who had an opioid addiction.
In October 2016, Cruz had just bought building supplies at Home Depot for an upcoming job when Loftus invited him to dinner. Cruz had recently checked out of a 30-day rehab program and was eager to get back to work. He was particularly excited about the next project because it would be the first he would be able to work on from start to finish.
Cruz declined the dinner invitation. Later that night, he was found at his aunt’s apartment in Queens, dead of an apparent overdose, lying next to a bag with the measuring tape and other supplies he had bought that evening.
Loftus was the last person to speak to Cruz. “That’s how it happens,” he said. “It’s that fast.”
Across the country, overdose deaths are on the rise. That is in part because many who are addicted to prescription painkillers may turn to street drugs such as fentanyl and other potent synthetic opioids, which health officials say are often mixed with other stimulants. The pharmaceutical industry has been widely accused of profiting off the nation’s opioid crisis, which killed nearly 645,000 people from 1999 to 2021, according to the CDC.
Cruz’s addiction started with painkillers that he had been prescribed after a car accident left him with lingering back pain. Eight years later, he had just earned his first paycheck after checking out of rehab when he died.
“He was hiding it well enough,” his sister, Lizbeth Rodas, said at her home in Morristown, New Jersey, which was adorned with framed family photos, including two of her brother. She described Cruz as both a jokester and a gentleman who was like a brother to her children. “We thought he was cured, and everything was back to normal.”
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 the pain. Rodas said she had begged him not to take it, and he complied.
“It was so scary for me, to think of going through the same thing again,” she said.
Cruz’s toxicology report showed traces of codeine, fentanyl and heroin in his system. Loftus, the union counselor, said most workers addicted to substances like heroin had been addicted to prescription painkillers first. Among workers’ compensation claims with at least one prescription, about one-fourth had one for an opioid, according to data from 40 states gathered by the National Council on Compensation Insurance.
Part of the challenge the industry faces is breaking the stigma of addiction. Rodas said that when she and her family were preparing Cruz’s funeral, they were unsure whether they should tell people he died of an overdose. Per their mother’s wishes, they chose to tell the truth.
“So many people came forward after that,” she said, including union colleagues.
Tackling such a pervasive issue is a gargantuan task for the industry’s safety leaders, who are used to protecting workers from physical injuries. Increasingly, construction companies are stocking job sites with Narcan, a brand name for the opioid overdose reversal medication naloxone.
“It’s not just about the physical safety of the workers on our job sites, it’s also what goes on when they’re not on the construction site,” said Rebecca Severson, director of safety at Gilbane Building Co., one of many that have started adding Narcan to its first-aid kits.
The Center for Construction Research and Training, a nonprofit created by a federation of construction unions, has sponsored research projects on the effectiveness of various mitigation measures, including having Narcan on job 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 on chemical exposure, which is a vital concern in an industry where workers can often handle materials containing asbestos and lead.
Cain did not initially see preventing overdoses as a particularly integral part of her job. Now, it is the most acute safety issue in her field. Since 2018, she has led the group’s response to the overdose crisis ravaging the construction industry.
“As I was preparing to create this task force, I cried,” Cain said. “It’s really beyond my scope of expertise.”
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