Ontario’s construction industry uniquely vulnerable to opioid-related deaths, new study reveals

Construction workers are dying of opioid-related causes in Ontario at a much higher rate than workers in other industries, according to a new study that found one in 13 opioid-related deaths in the province occurred among those in the sector.

The reasons behind this are a complicated mix of pain management, job insecurity and having nowhere else to turn, researchers say.

Nearly all of those who died had experienced a pain-related condition or injury in the five years prior to death, according to the study. Researchers say this underlines how those with little options for pain management in an industry where physical injury is common, may reach for opioids — with potentially disastrous consequences.

Workers were also largely dying alone in their homes, without family members or friends around to help, the study found.

The report, released Thursday, looked at opioid-related deaths in Ontario between 2018 and 2020 among current construction workers or those who had previously been in the industry.

“The first thing we found was that one in 13 deaths that happened over that timeframe, occurred among construction workers,” Dr. Tara Gomes, one of the authors of the study, told CTVNews.ca in a phone interview Tuesday. “So that was 366 people over the three year period who had an opioid related death.”

This means people in the construction industry made up nearly eight per cent of all opioid-related deaths in Ontario during that time, even though construction workers make up only 3.6 per cent of Ontario’s population.

Gomes explained researchers were first alerted to the need to research this population further in 2021, when they were performing a broader study on opioid deaths in Ontario among people who were employed at the time of death.

Within that data was a staggering statistic: 30 per cent of all opioid-related deaths among people who were employed were within the construction industry.

“The next employment category in that list […] represented only six per cent of people,” Gomes said.

“The construction industry stood out by far as an outlier.”

The new study echoes data from B.C., she said, but is the first of its kind to look at Ontario construction workers in particular, using data from the Office of the Chief Coroner of Ontario, as well as from non-profit corporation ICES.

DANGERS OF THE CONSTRUCTION INDUSTRY

The reasons why construction workers in particular are vulnerable to dying of opioid-related causes are complex, Gomes said.

One aspect is construction work can be inconsistent — a worker may have a lot of work in one month and be pulling double shifts, only to see that dry up a few weeks later.

“There's a lot of job insecurity, which leads to a lot of under reporting of injuries or pain and a lot of pressure for people to return to work, because if they're not working, oftentimes they're not being paid,” Gomes said. She added temporary workers hired for a specific project may not have health benefits and less job site training.

On top of this, construction work is one of the most dangerous and physically-demanding industries. According to the Association of Workers’ Compensation Boards of Canada (AWCBC), construction work is the top industry to experience fatalities at work.

Almost 80 per cent of those who died of opioid toxicity within the study period had an injury or were battling pain in the last five years, a statistic that echoes the greater trend of opioid-related deaths in general, even outside of the construction industry, Gomes said.

“Specifically, we saw a high degree of traumatic injuries and traumatic brain injuries in about 10 per cent of people who had evidence within the health-care system of having been injured on a work site in the last decade,” Gomes said.

Since those statistics only include those who ended up in hospital with an injury, which was then flagged as occurring on a work site, this is “most likely a vast underestimate of the actual number,” Gomes said.

The majority of those who died of opioid toxicity in the study time period were using opioids accessed through the illicit drug trade rather than opioids that had been prescribed, indicating the dangers of self-medicating, according to the study.

Cocaine and alcohol were also involved in a lot of these deaths, Gomes said, at a much higher rate than among non-construction workers.

She explained that this could be because workers are looking for stimulants to stay alert during long shifts or shifts at odd hours and then “using alcohol and opioids to unwind at the end of the day and also to manage pain.”

One thing the study points to is how many barriers there still are to accessing treatment for opioid addiction.

“About 60 per cent of people who died and who were construction workers had an opioid use disorder diagnosis,” Gomes said.

“So they might be people who would be eligible for treatment with access to drugs like methadone and buprenorphine that are very well proven to be a really helpful treatment option for people with an opioid use disorder.”

However, only a very low percentage were actually pursuing treatment for their opioid disorder prior to their death, the study found.

Gomes explained this is an issue that crops up when a person’s employment conflicts with the amount of time needed to pursue treatment — something that also explains why the level of prescription opioids involved in these deaths was so much lower among construction workers than other populations.

“Methadone in particular, is a substance where you have to go to the pharmacy every day in order to get your dose, for the most part,” she said.

“And that can be really hard for people who are employed and in particular people who might be employed in a job like the construction industry… where they might be working odd hours, their shifts might be changing around, and having to be at the same pharmacy at the same time every single day can be an incredible barrier to staying in treatment.”

DANGERS OF USING OPIOIDS ALONE

Gomes said one of the most dispiriting parts of the study was the finding that although the vast majority of these deaths were happening in people’s own homes, “it was pretty rare for there to be someone there who could have intervened.”

In the few cases when someone else was present, half of the time, Naloxone wasn’t administered.

One thing we can do to change this trend, Gomes said, is to increase awareness and education around opioid use by connecting people in the construction industry to more resources. However, since talking openly about substance use in the workplace could affect job security, it can be hard to find ways to reach certain groups without threatening their employment.

To help stop opioid deaths, Gomes said ensuring people know how to use Naloxone, which can help reverse the effects of opioid toxicity and save lives, is important.

Many people don’t know that Nalozone kits are free in Ontario, she added.

“They can go to almost any pharmacy in Ontario and get a free Naloxone kit. They do not have to show identification, and they can have that kit at home,” she said, explaining that the pharmacy will teach individuals who ask for a kit how to administer it.

“That can be a really simple step towards helping to reverse these overdoses, while making sure that people understand that it's really best for them to be using drugs when there's somebody around who can provide them with help.”

Outside of spreading awareness, Gomes said the next step is to talk to those opioid users in the construction industry to get a better idea of what they need.

“I think an important next step would be to really have policymakers engaging closely with the construction sector specifically, and not just the employers, but the people who are working within the sector […to] help open the door to an understanding of the right policy changes that might be able to be put in place,” she said.