The Silent Killer On The Job Site: Inside Construction's Battle With Opioids
The American opioid crisis was declared a national public health emergency Thursday, but the U.S. construction industry does not seem ready to take action regarding its own significant role in the deadly epidemic.
The trillion-dollar industry has been hit harder than almost any other sector of the economy in a health crisis that takes nearly 100 American lives each day. But it has been largely silent, more concerned about perception than the number of workers who are addicted to opioids.
Bisnow reporters reached out to — and were rejected by — 17 construction companies and workers at 27 construction sites nationwide. Only two executives were willing to speak on the record. Most explained away silence as not a sign of denial, but of fear over insurance hikes or not wanting to give the illusion they were operating “dirty” sites.
Nearly everyone agreed it was a problem with a solution bigger than one entity could handle, a problem they feel the industry needs to step up and tackle.
“This issue has come home to our front doors,” Suffolk CEO John Fish said. “Each member of the community needs to see this is at their front door.”
Boston-based Suffolk is one of the country’s largest construction firms, with an annual revenue of $3.3B, Fish said, and offices in Florida, California, New York and Texas. Suffolk’s headquarters is steps away from a stretch of Boston known locally as “Methadone Mile.”
Every day, hundreds of people line the sidewalks of this neighborhood. The area is known for a spate of methadone clinics steps away from the city’s pre-eminent bazaar for illicit drugs. Some of those seeking treatment in Methadone Mile or overdosing across the country work in construction.
Developers and construction company owners, speaking on the condition of anonymity, told Bisnow there is a problem in the industry, and it has made reliable labor an unattainable commodity across the country.
It is a case of all-hands-are-wanted-and-desperately-needed-on-deck in Massachusetts. More than 2,000 people are estimated to have died from opioid-related causes in 2016, up from only 379 in 2000, according to the Massachusetts Department of Public Health.
Boston Mayor Martin Walsh, a former building trades president and a recovering alcoholic who is 22 years sober, is a pivotal voice in helping Boston tackle the matter, International Union of Painters and Allied Trades District Council No. 35 Director of Organizing John Doherty said.
“Our groups inform each other of what is going on,” Doherty said. “He has been a great resource in terms of coming up with innovative ways in battling the epidemic and how we talk to members.”
For real change, efforts should come from more than local governments, he said. It needs to come from everyone impacted by the epidemic, including developers, the silent investors funding projects, union leaders, nonunion labor or just a passerby noticing someone in need of help.
“The more we can publicize this issue helps to change the stigma to get people to come out of their shells and speak about it,” Fish said.
The Need To Wake Up
Construction-specific data in relation to the opioid crisis is limited, but there are some clues as to how dire it has become. An estimated 15.1% of construction workers have engaged in illicit drug use, according to a report by commercial insurance underwriter CNA. This is second only to the food service industry. Others point to construction as being susceptible to the epidemic simply because of what gender is most prevalent in the construction workforce.
“The primary workforce in construction is male, and they’re twice as common to abuse prescription drugs than females,” said Eric Goplerud, senior vice president of the Department of Substance Abuse Mental Health and Criminal Justice Studies at NORC at the University of Chicago.
Construction workers, by the physical nature of their jobs, often suffer the wear and tear on the body that, in recent history, would have led doctors to prescribe opioid pain medication in order to allow them to return to the work site. But the short-term solution can have long-term ramifications, both personal and financial.
An Illinois-based construction firm of 150 employees could face $57,387 in lost time, turnover and healthcare expenses from substance abuse, according to a calculator, created by the National Safety Council, NORC and Shatterstock, that allows employers to enter their industry, organization size and location to determine how much substance abuse might be costing their company.
Using annual federal surveys on health and drug use, the groups pored over three years of data. They reinterviewed employed adults and asked about their occupations and industries in order to reach their findings.
In addition to being predominantly male, the construction workforce also tends to skew younger. Adults age 18 to 25 are more likely to abuse opioids than any other demographic, according to the National Institute on Drug Abuse.
The limited industry data available is already outdated. Quest Diagnostics Director of Science and Technology Barry Sample said his company is working to once again track drug use by industry. The U.S. Department of Health and Human Services had previously tracked the information through self-reported data of users over the age of 12, but it halted after the U.S. Department of Labor grant that funded the effort expired in 2014, Sample said.
Jim Johnson, CEO of G.E. Johnson Construction in Colorado Springs, Colorado, believes firms have been reluctant to speak publicly because they may not be aware of how far-reaching the opioid epidemic is. Johnson said he had no idea how prevalent it was until he read “Pill City,” an account of how two high school honor roll students used location-based technology to rob pharmacies and drug dealers of $100M worth of opiates during the 2015 Baltimore riots.
Johnson became determined to become an industry leader in the fight against opioids and is working with Face It Together, a drug advocacy group, to redesign its testing panel to add opioids and prescription drugs to its list of testable drugs. G.E. Johnson conducts drug screening for mandatory pre-hires, post-accident, for cause and randomly, but its testing panel is outdated. Currently, G.E. Johnson tests for alcohol, marijuana and amphetamines.
“In Denver, we were ready for legalized pot,” Johnson said. “For opiates, we’re far behind.”
For larger firms like G.E. Johnson, there are added obstacles to implementing a new, standardized drug testing policy. G.E. Johnson employs 800 workers in six states and farms out 80% of its work to subcontractors. Johnson said that, while those subcontractors are bound to G.E. Johnson’s commitment to running a drug-free workplace, the problems arise when those subcontractors hire other firms that are not on G.E. Johnson’s payroll.
Fish said universal drug screening, which would identify the scope of drug use, is the first step in taking down the opioid epidemic.
“I might be bold in saying this, but I think some of the traditional rules and regulations that have been in existence to protect workers’ rights in the 21st century are violating their rights,” he said. “We aren’t helping anybody by not screening them. Why are we doing it? To protect the worker.”
From Medication To Crisis
“It has deeply affected the workforce in general,” Doherty said. “It’s a shared responsibility and it has to be tackled on all levels. For whatever reason, [developers] don’t want to talk about it. They need to see it’s affecting all levels.”
There has been activity in the trades and the recovery communities in getting workers the help they need. Labor Assistance Professionals meet to raise awareness, according to Doherty, and there are also employee assistance professionals available to get people to proper care.
“We try to educate our members on the path to recovery and insure their privacy is held close. There is a problem and there are ways to deal with it,” Doherty said. “A lot of it is anti-stigma messaging. The stigma is a big piece of relapse and why people don’t seek out help.”
The stigma might be exacerbating the problem, but it is not its root cause. While doctors knew one could become physically dependent on opioids, the commonly held belief in medical circles was it would not lead to a substance abuse problem.
“We, as healthcare-givers, are at fault for having put a lot of opioids out there,” Newton-Wellesley Hospital Director of Substance Use Services Dr. Antje Barreveld said.
The United States, which accounts for only 5% of the world’s population, consumes 80% of the world’s opioid supply. The medical community’s decision that opioids were the best way to treat pain flooded the market with unused prescriptions that got into the hands of people simply looking to get high, according to Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Director Kimberly Johnson.
It was not until the mid-2000s, when prescription monitoring programs surfaced, that the medical community realized just how many opioids people were getting, she added. The problem has become so bad that it has moved beyond educating and promoting prevention. The biggest issue now is simply keeping people alive.
“It’s absolutely out of control, and there is no reason why we can’t do something about it, but it takes a lot of people,” Barreveld said.
Goplerud said that the average construction worker addicted to opioids has been on pain medications for at least six months, and believes that employers should assess when a worker who is physically rehabilitated from an injury is actually ready to return to the job. If the worker has been prescribed opioids as medication, the assessment should include how to get off them.
“Helping wean workers off opioids as they prepare to return to work should be part of any rehabilitation treatment,” Goplerud said.
A Worker Tests Positive. Now What?
Getting construction company owners to seek help for employees who test positive on a drug test is not going to come easily. Many construction sites have zero tolerance policies so, when a test comes back positive, it often means termination — not finding the worker help.
“You go on construction sites, and you see those signs saying ‘you’re out of there if you test positive,’” Boston Properties Life Safety and Security Assistant Director John Tello said. “It seems like there is a divide in what’s going on and what needs to be done to help these people.”
Even if the majority of the industry clams up on the matter of opioids, at least one construction company seems ready to help. At a time when a bulk of Greater Boston’s development activity surrounds the city’s tourist magnet Seaport neighborhood, Suffolk is moving ahead with a $60M renovation and expansion at its office blocks away from Methadone Mile. Fish said doubling down on Roxbury is a message of care.
“People think I’m crazy,” Fish said. “My attitude is, why wouldn’t you invest in an area that can change people’s lives and be a catalyst for opportunity?”
Suffolk has invested in Walsh’s initiative to build shelters on Methadone Mile, it trains employees how to use opioid overdose reversal treatment Narcan and has close relations with the nearby Boston Medical Center, which received a $25M donation (the largest in the hospital’s history) from billionaire investor John Grayken and his wife, Eilene, in 2016.
The hospital said the money will go toward launching the Grayken Center for Addiction Medicine, which further advances the hospital’s status as a pre-eminent center for addiction research, training and prevention. The couple, usually anonymous in their philanthropic efforts, said at the time they went public to help destigmatize the issue.
While every union is an entity unto itself and tailors treatments to the individual, Massachusetts Building Trades Council President Frank Callahan’s organization seeks help if an individual tests positive for a drug screening. Leaders see it as beneficial in the long term as opposed to employment termination. Routine testing and providing help are also a matter of workplace safety.
“I could be clean and if you’re working 20 feet above me in an impaired state and drop something, that doesn’t help,” Callahan said. “Fortunately or unfortunately, we’ve been way ahead of the curve in substance abuse treatment in the trades and labor.”
At Suffolk, Fish said finding the help employees need is absolutely at the top of his mind. He said the company would do everything in its power to ensure its addicted employees are treated, not fired.
“There are quite a few people in this world trying to turn a blind eye,” Fish said. “If it doesn’t affect you, it’s not the most popular thing to talk about.”
The secret should be out in construction. The opioid epidemic is already touching job sites, making labor more scarce and more expensive. The longer the silence continues, the more the stigma grows, the more lives are at risk.