For the first time in U.S. history, a person is more likely to die from an accidental opioid overdose than from a car crash, according to the National Safety Council. But, while the NSC reports that 75% of all employers say they have been directly impacted by opioid misuse, just 17% feel extremely well-prepared to address it.

And few industries have felt the opioid crisis more acutely than the construction industry. According to a report released in January 2020 by The Center for Construction Research and Training, unintentional overdose fatalities on the jobsite numbered 65 in 2018, a 35.4% increase from 48 overdose deaths in 2017 and an alarming leap from the seven recorded in 2011.

While construction workers are more at-risk than other professions (they are more likely to experience an on-the-job injury resulting in opioid prescriptions, per the U.S. Bureau of Labor Statistics), findings in a 2017 NSC survey indicate that substance use disorders in the industry are higher than a term like “at-risk” might suggest. Sky high. The survey found an estimated 8.6% of the U.S. workforce was battling a substance abuse disorder; simultaneously, 15% of construction workers were facing the same disorder.

Confronting such substantial odds of such a critical nature, industry stakeholders are coming up with inventive tactics for rolling that ball up the hill.

Construction Companies

An integral facet of any company’s safety program is mental health and wellness, to include an opioid and substance use policy. “There is no doubt that the (mis)use of opioids is a leading concern for the construction industry,” says Katie Coulson, HR manager at Kwest Group. But in a physically demanding, time-consuming industry, Coulson says that Kwest’s answer is to treat the symptoms before they become chronic. With a motto of “Beating Before. Diminish During. Accomplish After,” Kwest’s policy emphasizes communication, encouragement and healthy choices over retired alternatives, such as punishment and shame.

First, employers should encourage team members to understand the risks of opioid abuse—misuse, addiction, physical dependence, overdose and risk to others. “If we respond before it becomes a struggle, we diminish the percentage of people who struggle during addiction—and can accomplish a higher ‘after’ struggle success rate,” Coulson says. This commitment to employee success, and getting in front of the problem, is why education and communication are fundamental to the process.

Second, Kwest’s drug policy is visible and finite from day one of employment. Beyond drug testing pre-employment or other, random drug tests, team members are given daily check-in booklets, participate in required annual training and must recertify a personal acknowledgement of the drug-free workplace policy on an annual basis. Supervisors are provided with an additional training and are furnished with a reasonable suspicion toolkit to identify the signs and symptoms of a potential situation.

“Kwest’s number one core value is and always has been safety,” Coulson says. This has meant bridging any possible gap, to include requiring disclosure of medications that may impair the ability to safety perform duties; partnering with a 24/7 telephonic nurse and case management specialist; providing referrals to Employee Assistance Programs or a Substance Abuse Professional; encouraging employees to prevent chronic pain via annual screenings; and communicating the availability of all company, local and national resources.

For Coulson and Kwest, combatting the epidemic means creating a stopgap (and an option) at every possible source. “Leaders in the construction industry have no choice but to beat this before it becomes an addiction,” Coulson says. And the heftiest levee in the fight? “Talk about it.”

Once an employee at Kwest has an addiction, there is one option: “Seek help,” Coulson says. “If you need help, we can direct you to the appropriate treatment program or resource.”

Insurance & Surety Brokers

HUB International is an insurance broker with about 25,000 clients in the construction space. With opioid and general drug use on the rise, HUB answered calls for information in the form of an educational webinar, “The Evolving Drug Crisis in Construction: The Reality and the Risks of Substance Abuse on Jobsites.” One of the featured educators from the CE webinar, HUB’s Vice President of Risk Services Phil Casto, says it is important for clients to know that there is a certain path forward in uncertain times.

“We get a lot of questions about how to put together a policy, what best practices are for opioid addiction, how to address a person becoming addicted after being subscribed—that kind of material,” Casto says. “There are some common sense steps to take that anybody in the construction space could take to develop a better policy for their own internal company and better address that risk issue.”

From the preventative aspect, Casto recommends implementing an EAP so that when a person becomes addicted, they have a resource or outlet available to them without repercussion. He also recommends that companies train supervisors to be able to identify someone under the influence of drugs or alcohol—termed “reasonable suspicion training”—to develop a testing policy for those suspected individuals, as well as to provide them with appropriate assistance.

“That’s what our role is,” Casto explains. “To help companies address the issue, put a policy in place and take care of the employees when an issue does arise.”

Beyond recommending EAPs, HUB International facilitates training, which is derived from the Federal Motor Carrier Safety Administration’s regulations for supervisors of commercial motor vehicles. HUB recommends that all employees in a supervisor role should have training on how to identify and document suspected drug and alcohol use. “Most companies didn’t have a policy for that, and they weren’t sure what to do when they encountered it,” Casto says.

Rather than create an atmosphere of enablement, HUB International advocates for accountability, education and, like Kwest, a path to recovery.

While public awareness has improved for construction and other high-risk industries, the fight is far from over. “It’s not like opioids aren’t being prescribed anymore,” Casto says. “But I think people have come to understand that this type of drug addiction happens to good people, and getting the word out has made it less of a taboo.”

Casto’s biggest piece of advice to employers is apropos of his interest in publicizing the epidemic. “Have a program and talk about it,” he says. “You want to make sure there’s a pathway to bring a person back into the workforce because that individual still has a lot to contribute and this addiction doesn’t define who they are.”

Statewide Initiatives

While employers need to arm themselves with education, training, policy and compassion, it is critical that employees seeking help and treatment can find a support system in their employers.

The Recovery Friendly Workplace Initiative in New Hampshire focuses on that piece of the puzzle. Established in March 2018, the initiative was created, in tandem with Gov. Chris Sununu’s Advisor on Behavioral Health and Addiction Dave Mara, to work with employers in the state to create supportive work environments for people impacted by substance use disorders.

“We want to address issues like addiction head-on,” says Program Director Shannon Bresaw. “We want to challenge the stigma people face as it relates to addiction and connect people to resources and support so they are able to be successful in the workplace.”

At present, besides more than 250 participating workplaces in New Hampshire (which represent a collective 70,000 employees), the Recovery Friendly Workplace Initiative has also seen its model adopted in full or in part by more than 15 states, due to the program’s ease-of-use and availability as a platform for other recovery-friendly, state-run programs.

One of the more enthusiastic clients has included the Associated Builders and Contractors New Hampshire & Vermont Chapter. As an industry partner, ABC Chapter President Joshua Reap, who has already extended several invitations, will make the work of “getting the word out” easier on Bresaw and her team so they can focus on providing support.

The initiative operates with “boots on the ground” support—from the public health network to local recovery organizations to its own, trained employees. Bresaw describes the approach as more concierge than clinical. That approach could mean peer-to-peer learning sessions between companies, a toolkit and resources or assistance from a Recovery Friendly Advisor (RFA). Each workplace is assigned a RFA, who provides customized, one-on-one support; connects workplaces to resources and peers; and guides them through a checklist process that aids in the development of a recovery-friendly culture.

“We work with each of the businesses in a different way because we’ve found that businesses are really looking for a customized approach,” Bresaw says. “They share some challenges, they share some strengths, but oftentimes certain businesses face very particular challenges; we want to help them identify what those are and really work with them on an individual basis.”

In New Hampshire alone, the annual cost of substance misuse is $2.36 billion, per a 2017 PolEcon report sponsored by New Futures. According to the report, the majority of those costs can be attributed to absenteeism and decreased job productivity. The impact of being recovery friendly is multifaceted, but includes the ability to implement supportive policies and practices that result in a tangible return on investment—more dedicated, healthy and loyal employees.

The bottom line, Bresaw says, is that you have to look at recovery—and at being recovery friendly—“as a continuum.” Meaning that employers should focus less on emulating the same policies and more on the final result: breaking stigma and decreasing barriers to recovery. “What we’re trying to do is make it easier for people to have a conversation saying that they need support, and for employees to be empowered and educated on what that means in their workplace.”

The nuance for employers is taking actionable responses that utilize the available data, while prioritizing mental health, physical health and worker safety. A lot of companies would say it’s a tall order. But those companies haven’t worked at height before.