THE VICTORY IS BITTERSWEET for Mike Yorke, president of the Carpenters Union District Council of Ontario. Every first aid kit, on every construction site in Ontario will soon include naloxone, a drug that can temporarily reverse the effects of an opioid overdose. Yorke’s happy about that. He’s not happy that it is so necessary.
It’s necessary because opioid overdose kills a lot of construction workers—a higher proportion in their industry, by far, than for workers in any other industry. In the first 10 months of the pandemic, one third of the people working in Ontario who died from overdose worked in construction.
‘The Other Pandemic’
The construction unions and their industry united in May 2021 to launch “The Other Pandemic”—a campaign to prompt action to deal with the issue. The campaign included a website, news releases and media interviews.
The campaign urged workers not to use opioids alone and to only use with a naloxone kit handy. It also called for the Ontario government to increase access to mental health and addiction services.
A year later the Ontario government announced their decision to require the life- saving naloxone on every construction site. The legislation also requires there to be at least one person on site at all times who is trained in administering naloxone. The kits are expected to roll out in the fall.
A signal victory
“This is one of the first times I have ever been involved in a project from inception right thorough to seeing legislation being proposed at Queen’s Park,” said Yorke. “The fact that naloxone kits are now going to be circulated on job sites, that was a recommendation advocated for by the Ontario Drug Prevention Network, and the Ontario Construction Consortium through The Other Pandemic.
Aaron Sinclair says he hopes the naloxone kits will come with an information campaign to boost awareness of their importance across the industry, especially when there is still broad stigma around opioid use. Sinclair is the executive director of De Novo, an addictions treatment facility created by UA Local 46, the union representing plumbers, steamfitters and welders, specifically for members of the construction industry.
“When you talk to people about a first-aid kit, everyone’s like, ‘yeah, of course.’ But when you think about things like a naloxone kit, there’s still a lot of resistance,” he said.
Questions remain around whether the naloxone action will be enough to meaningfully address opioid-related deaths in the industry, where use happens both on and off work sites.
“We don’t believe most overdoses are occurring on the job,” says Phil Gillies, executive director at the Ontario Construction Consortium, “but if the kits are available for workers to take home with them—that’s where more of the benefit is.”
“It’s a late-stage intervention,” said Dr. Andrea Sereda, a physician in London, Ont., who runs a safe opioid supply program in the city. “It is the final straw that the government can offer.”
A New York University study found that construction workers had a higher rate of misusing prescription opioids than any other line of work.
Cristina Selva, executive director of the College of Carpenters in Ontario, says, “I think the reasons for substance abuse, regardless of whether it’s opioids or alcohol or marijuana, are all the same: it’s mainly driven by the industry’s relatively high rate of physical injury, leading to a reliance on substances like non-prescription opioids to numb chronic pain.
Selva added that the contractual nature of the work can also be a cause for stress and anxiety, leading some to turn to drugs to cope. “There are longer periods of unemployment, and that causes tremendous stress on people who have families and mortgages.”
Mental health issues
In the past three years, Selva said, the industry has made progress on improving physical safety on work sites. But it has been largely silent on mental health, save for a few initiatives at local colleges and unions. Drug use and mental health, she said, “are still a largely taboo subject” among the male-dominated workforce.
Dr. Sereda said that before the COVID-19 pandemic, her program in London had enough capacity to help both acute patients and people in the construction industry whose opioid use was more moderate.”
Since the COVID-19 pandemic, however, Sereda’s program has been overwhelmed with people with more acute problems, including those who are struggling with homelessness and other complex mental health challenges. The capacity to help those who are less acute, she added, is no longer there, and policymakers should focus on growing all avenues of care and harm reduction — including expanding safer supply and opioid substitution therapy programs.
“I will always advocate for more accessible naloxone, but we need upstream intervention,” Sereda said. “We shouldn’t be patting ourselves on the back for giving people a solution when they’ve already died from the problem.”
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