Construction workers disproportionately impacted by opioid-related deaths, report finds

Nearly one in 13 opioid-related deaths in Ontario between 2018 and 2020 occurred among construction workers, and among construction workers who died over half were employed at time of death, according to a new report.

The report shows deaths among construction workers are primarily being driven by the unregulated drug supply – not pharmaceutical opioids prescribed for pain – with cocaine and alcohol being more commonly involved in opioid toxicity deaths among construction workers compared to those not working in the construction industry.

The findings come as Canada continues to face a rapidly growing opioid overdose crisis, and highlight the need for industry-level responses to the ongoing overdose crisis within the construction sector.

The report was led by researchers from the Ontario Drug Policy Research Network (ODPRN) at St. Michael’s Hospital, a site of Unity Health Toronto, ICES, the Office of the Chief Coroner for Ontario and Public Health Ontario.

“The disproportionate impact of Ontario’s overdose crisis among people working in the construction industry demands further attention,” said Dr. Tara Gomes, lead author of the report, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and ICES, and a principal investigator of the ODPRN. “Importantly, despite a high prevalence of pain among workers, prescription opioids are not driving the patterns seen in this industry, with most deaths involving a combination of opioids with other drugs and alcohol. This could reflect a reliance on non-prescription opioids to manage unresolved pain in a sector where workplace culture and lack of job security can lead to under-reporting of injuries and pressure to minimize recovery time.”

Researchers identified people who worked in the construction industry who died of an opioid toxicity in Ontario between July 1, 2017 and December 31, 2020. The researchers defined construction workers as individuals who were employed or previously employed in the construction industry prior to death, as determined by the investigating coroner. This includes work in a trade, equipment operation, or general labour.

Over the study’s 30 month span, 428 Ontarians with employment history in the construction industry died of an opioid toxicity, accounting for nearly 1 in 13 (nearly 8 per cent) of opioid toxicity deaths during that time. In contrast, people working in the construction industry represented only 3.6 per cent of the entire Ontario population and 7.2 per cent of all employed people in Ontario in 2021. Previous reports have showed that, one-third of people who died of opioid toxicity and were employed at time of death worked in the construction industry.

Using data from ICES and the Office of the Chief Coroner of Ontario, researchers explored the circumstances surrounding the deaths and found:

• Fentanyl and cocaine involvement were significantly higher among those with employment history in construction compared to those without. Alcohol also directly contributed to one in five opioid toxicity deaths among construction workers, which was significantly more common compared to those without a history of employment in construction
• Nearly 80 per cent of opioid toxicity deaths among construction workers occurred in private residences, most often the individual’s home, and rarely at construction sites or motels/hotels used for work purposes.
• Among cases where an individual was present to intervene in the overdose, naloxone administration decreased slightly over time among those who died of an opioid toxicity and had worked in the construction industry, suggesting the need for increased accessibility to naloxone in this population, including in people’s homes and not just on work sites.
• Only one in six construction workers with an opioid use disorder (OUD) diagnosis who died of an opioid toxicity had accessed treatment in the month before death, which is lower than what was observed among those with no history in construction.

The report also describes demographic characteristics of people who worked in the construction industry who died of opioid toxicity:

• Nearly 60 per cent of individuals in the construction industry were employed at the time of opioid toxicity death, compared to only 12 per cent of those with no employment history in the construction industry.
• Pain was highly prevalent among construction workers who died of opioid toxicity – almost 80 per cent experienced a pain-related condition or injury in the five years prior to opioid toxicity death, which was similar to those with no employment history in construction.
• Opioid toxicity deaths were more concentrated among those aged 25 to 44 years, with almost two-thirds of deaths among people who worked in the construction industry falling in this age group.
• Over 98 per cent of construction workers who died of an opioid toxicity were male, compared to 72 per cent among those without a history of employment in the construction industry. This is consistent with the sex distribution of the construction industry workforce in Ontario.

The authors of the report are calling for industry-level responses in the construction industry that recognize the stigma around drug use, which may make people less likely to engage in treatment and harm reduction services offered through their employer. To address this stigma, industry-level responses should also include improving access to naloxone within homes, raised awareness about how to use drugs more safely and using multiple drugs, and low-barrier access to evidence-based treatment – such as removing the requirement to go to a pharmacy to consume a daily dose methadone or buprenorphine under medical supervision – as well as pain management and mental health supports.

“The report shows that young men continue to die from preventable opioid-related deaths. Each death is a person who lost their life. Their families have lost a loved one, their communities have suffered a loss, and coworkers have lost a colleague and friend. Developing policies to address the stigma and provide support and harm reduction services at the workplace will help prevent further opioid-related deaths,” said Dr. Dirk Huyer, chief coroner for Ontario.

The report was funded by the Government of Ontario and the Canadian Institutes of Health Research (CIHR).

About St. Michael’s
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About the Ontario Drug Policy Research Network
Established in 2008, the Ontario Drug Policy Research Network (ODPRN) is a research program based out of St. Michael’s Hospital that brings together researchers, people with lived experience, clinicians, and policy-makers to generate evidence to inform effective drug policy development in Ontario.

About Unity Health Toronto
Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.

About Public Heath Ontario
Public Health Ontario is a Crown corporation dedicated to protecting and promoting the health of all Ontarians and reducing inequities in health. Public Health Ontario links public health practitioners, front-line health workers and researchers to the best scientific intelligence and knowledge from around the world. For the latest PHO news, follow us on Twitter: @publichealthON.

About the Office for the Chief Coroner
Together the Office of the Chief Coroner/Ontario Forensic Pathology Service (OCC/OFPS) provide death investigation services in Ontario serving the living through high quality investigations and inquests to ensure that no death will be overlooked, concealed or ignored. The findings are used to generate recommendations to help improve public safety and prevent further deaths. In Ontario, coroners are medical doctors with specialized training in the principles of death investigation. Coroners investigate approximately 17,000 deaths per year in accordance with section 10 of the Coroners Act. The OFPS provides forensic pathology services in accordance with the Coroners Act. It provides medicolegal autopsy services for public death investigations under the legal authority of a coroner. The OFPS performs approximately 7,500 autopsies per year. For more information, visit Office of the Chief Coroner and the Ontario Forensic Pathology Service | ontario.ca

About ICES

Media contacts:

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Stephanie Rea
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