In 2020, an average of 44 people died every day from overdoses involving prescription opioids, according to the Centers for Disease Control and Prevention (CDC), The total number of deaths was more than 16,000 that year. In addition, about 20% of all opioid deaths in 2020 involved heroin.

The construction industry has one of the highest opioid use and overdose fatality rates in the country, and construction workers represent roughly 25% of fatal overdoses among all workers. Below are some safeguards employers and workers can take.

Opiates vs. opioids

Opiates and opioids are not the same. Opioids are pain-relieving chemical compounds that fall into three different categories: natural opiates, semisynthetic and synthetic opioids. Opiates refers specifically to the natural opioids originating from the opium poppy, such as morphine and codeine. Semisynthetic opioids include heroin and the prescription drugs hydrocodone and oxycodone.

When opiates or prescribed semisynthetic opioids are used as intended, they can greatly reduce pain intensity. However, they can also cause mental confusion, nausea, drowsiness and constipation, and can even affect breathing. These side effects become a greater issue when opioid use leads to dependence or addiction. This addiction is typically linked to those coping with pain from injuries or ailments affecting three or more areas of the body. Many heroin users started by taking prescription opioids.

Construction workers are at higher risk of opioid abuse because of the physically demanding nature of the work and the need to produce. Failure to perform could result in the loss of a job and income. 

As a result, the dangers associated with addiction or health risks caused by abusing these drugs are often ignored. It’s estimated that 15% of all construction workers in the United States have a substance abuse disorder, compared to 8.6% of the general adult population, according to the American Addiction Centers.

Synthetic or manufactured opioids include methadone, tramadol and fentanyl. According to the CDC, “Fentanyl is 50 to 100 times more potent than morphine. Fentanyl analogues, such as carfentanil, can be 10,000 times more potent than morphine. Overdose deaths from fentanyl have greatly increased since 2013 with the introduction of illicitly manufactured fentanyl entering the drug supply.” More than 75% of all opioid overdoses are linked to fentanyl.

Having naloxone on-site

With the explosion of fentanyl, which is appearing in more legal and illicit substances, deadly drug overdose cases are at an all-time high. However, the drug naloxone hydrochloride can almost instantly reverse an opioid overdose. Also known as naloxone, Narcan or Evzio, it is often carried by first responders, emergency medical services providers and nonemergency professional responders. According to the CDC, “Naloxone is a drug that can temporarily stop many of the life-threatening effects of overdoses from opioids. Naloxone can help restore breathing and reverse the sedation and unconsciousness that are common during an opioid overdose. Serious side effects from naloxone use are very rare. Using naloxone during an overdose far outweighs any risk of side effects.”

In the event of a suspected overdose where the victim’s symptoms were not caused by an opioid, administering naloxone is unlikely to cause further harm. In very rare cases, it may result in acute opioid withdrawal symptoms, which can include body aches, increased heart rate, irritability, agitation, vomiting, diarrhea or convulsions. Allergies to naloxone are extremely rare. However, it won’t work on overdoses from other drugs, such as alcohol, benzodiazepines or cocaine.

On March 29, 2023, the Food and Drug Administration approved over-the-counter sales of naloxone. In most states, naloxone can be purchased at pharmacies without a prescription. It comes as a nasal spray or in an injectable form such as an auto-injector, prefilled syringe or standard syringe/needle. 

Many contractors have expressed liability concerns about simply  having naloxone on site. However, given that adverse reactions to the drug are extremely rare, that’s not a significant issue. Some smaller contractors worry about cost, but the loss of life is far greater than any expense to prevent death.

In states that permit nonlicensed providers to administer naloxone, employers should have the drug available. Employers should train employees how and when to use it and establish programs, policies and procedures for administering the drug. If nonlicensed people are not permitted to give naloxone, organizations should still have a draft program ready to launch. The Canadian government is in the process of requiring employers to have the drug. It’s likely only a matter of time before we see similar requirements in the United States.

Header image: stock.adobe.com / Rick