J’ette Novakovich, PhD, Assistant Coordinator for the Construction Sector in the NIOSH Office of Construction Safety and Health; Scott Earnest, PhD, PE, CSP, is the Associate Director for Construction Safety and Health; CDR Elizabeth Garza, MPH, CPH, Coordinator for the Construction Sector in the NIOSH Office of Construction Safety and Health; Douglas Trout, MD, Deputy Director for Construction Safety and Health in the NIOSH Office of Construction Safety and Health
Purpose/Objectives
The COVID-19 pandemic has worsened the nation’s drug overdose epidemic with both forces significantly impacting the safety, health, and well-being of the construction workforce. Our program is engaged in developing strategies to stem the tide of overdose deaths and help the rising numbers of construction workers suffering from opioid misuse disorder and poor mental health and the COVID-19 pandemic.
Background
Our program has formed partnerships with industry and labor. Working together we develop communication and training interventions to address emerging concerns in the construction sector.
Methods
The methodology we use for developing communication and training interventions is based on a recent study published by CPWR. The Center for Construction Research and Training, Preventing Opioid-Related Harms in the Construction Industry (Roelofs et al. 2021). CPWR developed evidence-based guidelines and recommendations to prevent opioid misuse disorder and provide help for those who are suffering. To frame our messaging correctly, we address the following questions: – What are the factors that feed into worker health and safety? – What are the conditions that lead to opioid addiction? As a basis for targeting communication and training materials, we monitor CDC MMWR reports and Vital Statistics, state reports, workers? compensation claims, and the literature. In addition, we also conduct field interviews and studies with key stakeholders.
Findings
The United States saw a record number of drug-related deaths in 2020. Total deaths exceeded 93,000, up 29 percent from 2019 (CDC Vital Statistics 2021). This translates to 250 lives lost every day of the year to drug overdose.
The construction industry has the second-highest rate of pain medication and opioid misuse of any industry. Between 2011-2016, construction workers experienced about 15% of the overdose fatalities (Tiesman 2019). Overdose deaths among construction workers increased 9x from 2011-2018 (Dong 2018).
The highest rate of injuries occurred in the construction sector (CPWR 2017). MSDs are prevalent among construction workers, and prescription opioid use significantly increases among workers with MSDs. About 34% of construction workers have at least one MSD symptom (Dong 2020). Prescription opioid use is 3x higher among construction workers with MSDs compared to construction workers without MSDs (Dong 2020).
The pandemic has also impacted people who have been struggling with poor mental health. In 2020, 1 in 3 people in the U.S. reported having anxiety or depression symptoms, a sharp increase from 2019 (Household Pulse 2021). Economic hardship and social isolation has affected mental health and disrupted access to addiction support and thereby increased overdoses and deaths during the pandemic (Wang 2020). Health disparities in the Hispanic community make them a particularly vulnerable population of the construction workforce. Hispanics make up 1/3 of the construction workforce (CPWR 2017). Only 18% of the US population, Hispanics make up 29% of the COVID-19 cases (CDC COVID Data Tracker 2021). From 2014-2017, drug overdose death rates involving synthetic opioids rose 617% for Hispanics (SAMHSA 2020). Higher numbers of Hispanics (40%) reported feelings of depression during the pandemic compared to Whites (25%).
Discussion
Our findings from the literature, field studies, and surveillance reports informed a suite of communication and training interventions. In the past year, we developed the following materials in response to this public health crisis: Co-sponsored Opioid Awareness Training for construction workers Published and disseminated infographic on suicide awareness. Publishing a series of videos comprised of public health testimonials on opioid misuse disorder and overdose deaths Developing a series of infographics framing upstream preventions for opioid misuse disorder and downstream help to prevent opioid overdose deaths. Added opioid misuse disorder and overdose as an occupational hazard in the construction industry on our program website.
Conclusions
In addition to communicating the big picture and systemic issues to construction decision-makers who can change conditions for the workforce, we are also reaching out to the people most affected, those who are struggling with mental health and substance misuse disorder. Improving workplace health and safety policies for the construction industry can act as a dam upstream that prevent injuries and the risk of opioid use disorder from developing downstream.
Employers need to take steps to address this problem, such as: providing paid time off to allow employees time to heal, disseminating information on alternative treatments, eliminating zero tolerance policies, establishing peer support programs, ensuring that employees have access to medical and mental health services, creating a safe environment where workers can discuss substance use, and establishing a harm reduction program to prevent overdose deaths.
Most importantly, employers can identify factors that pose a risk of injury or stress and take action now to prevent injuries and stress from leading to prescription opioid use or self-medication.
Culturally appropriate messaging must also be developed and effectively disseminated to reach and protect all impacted populations.