Construction leaders are urged to prioritize the prevention of musculoskeletal injuries and acknowledge the real risk of opioid overdose within the industry. By stocking naloxone and training staff to respond to emergencies, companies can implement a proven, lifesaving strategy that reduces fatalities and reinforces a culture of proactive safety.
For over a decade the percentage of occupational fatalities attributable to unintentional overdose of alcohol and substances rose to 9.7% in 2023, according to the Centers for Disease Prevention and Control (CDC).
Unfortunately, the data did not identify overdoses by industry so it lacked relevance and failed to create urgency. However, in August 2023, the CDC reported the first data highlighting substance overdose rates separately by occupation and industry level. This should have been a clarion call to action.
Highest Rate of Fatal Overdose Deaths
Among 22 occupational groups, construction and extraction ranked highest at 162.6 per 100,000 workers. The median was 42.1 for all listed occupations. Likewise, construction also was highest among 19 major industries. The median for all 19 industries was approximately 41.3 per 100,000 workers whereas the rate for construction was 130.9 fatal overdoses per 100,000 workers.
The CDC determined the construction industry accounted for 5 of the 10 individual occupations with the highest drug overdoses. Elevated fatal overdose death rates were delineated for at least 17 specific construction occupations. Among these, the top three highest included:
- Roofers—177.4 per 100,000 workers
- Drywall installers, ceiling tile installers, and tapers—175.1
- Painters, construction and maintenance—162.1
The analysis summarized important findings showing construction are more likely to report recent drug use than workers in many other occupations and industries. This conclusion identified numerous intersection causal and contributing factors including high injury rates, opioid prescriptions for pain management, as well as insufficient paid time off for sufficient injury recovery and rehabilitation.
Overlapping Risks
The construction trades are demanding and strenuous. Trades workers face many physical risks in their jobs, including both acute and chronic pain from musculoskeletal (MSK) injuries. Common MSK injuries sustained by trades workers include sprains, strains and repetitive motion disorders. Pain contributes to sleep deprivation and fatigue. Pain from on- and off-the-job injuries frequently leads to prescriptions for pain management that all too frequently have been opioids.
According to Tim Pottorff, the founder of QP3 Ergosystems, “the construction industry has a high frequency of work-related musculoskeletal disorders (WMSDs), with an overall injury rate that is 77% higher than other industries.” Pottorff cites data from the CDC “that 34% of construction workers will have at least one WMSD and that construction workers with WMSDs are three times more likely to be prescribed opioids.”
The National Council on Compensation Insurance (NCCI) evaluated opioid prescription use across major industry groups in 2020 and determined in the contracting industry, the “quantity of opioids prescribed to injured workers is more than double the average number prescribed to those in all other industry groups.” Moreover, “these contracting industry group claimants, on average, receive both 20% more opioid prescriptions and opioid prescriptions that are 20% stronger.”
As a career risk management and safety professional, the adage an ounce of prevention is worth more than the pound of cure has always held merit to me. Clear and compelling data supports the assertion that MSK injury prevention is the most effective opioid first dose prevention strategy. To this end, I sought advice once again from my former coworker and long-time collaborator Tim Pottorff, a certified industrial ergonomist known for being practical and resourceful. See text box on page 67.
Chronic Pain
Chronic pain is a real, complex medical condition. It is important to be sensitive and avoid judging and shaming those experiencing chronic pain. In 2023, the CDC reported 24.3% of adults experienced chronic pain. 8.5% of adults experienced high-impact chronic pain resulting in substantial restriction to daily activities. 34.9% of adults afflicted with chronic pain experience the high impact version of chronic pain. Both chronic pain and high-impact chronic pain increase with age.
The research highlights the that chronic pain and high impact chronic pain share these characteristics: “the most common reasons adults seek medical care, associated with decreased quality of life, opioid misuse, increased anxiety and depression and unmet mental health needs.” This data shows the value of MSK injury prevention.
Nonpharmacological Pain Management
In 2024, Texas A&M University reported on a pilot study evaluating the prevalence of pain among construction workers and found “85% of participants reported having pain or discomfort in the past year, and 72% reported using pharmacological pain management approaches, including 19% who reported using opioids.”
Significantly, the purpose of the pilot study was to determine the familiarity among workers to nonpharmacological pain management methods that do not involve medication prescribed by a health-care provider. The report summarized many nonpharmacological options, including “physical therapy, occupational therapy, over-the-counter medications, chiropractic care, acupuncture and acupressure, meditation, topical ointments, music therapy, cognitive behavioral therapy and spiritual healing, among others.”
Perhaps most importantly, the pilot study estimated “nonpharmacological approaches could result in an estimated 23% reduction in pharmacological pain management approaches.”
Strategies to Help
Nearly two decades ago, a work-related car accident left Becky Curtis facing a life of chronic pain. Today, as a National board-certified health and wellness coach (NBC-HWC) and director of strategic partnerships at Override Health, she uses that experience to help others find a way forward.
Becky’s personal recovery was built on learning effective coping skills and alternative therapies rather than a reliance on opioids—a struggle she feels fortunate to have avoided. Now, she coaches individuals and organizations on these same evidence-based strategies, helping people reclaim their lives from chronic pain and reduce their dependence on medication.
Curtis offered tips for employers to help employees address chronic pain and to reduce the risk of long-term opioid use:
- Identify occupational medical clinics who understand the inherent risks and limitations of treating occupational injuries with opioids.
- Consider physical therapy first for worker’s compensation MSK injury management.
- Educate employees about alternatives to opioids for pain management and how to talk to medical providers about alternatives for themselves and family members.
- Monitor follow-up appointments and identify modified duty assignments to ensure workers stay connected to work and the workplace while they recover and heal from the injuries.
- Teach employees about proper disposal of leftover opioid prescriptions, using drug takeback programs or the availability of drug deactivation and disposal products.
Teach brain science right from the beginning, including how the brain processes pain and medications.
What Is Naloxone and How Does It Work?
Naloxone (Narcan) is the generic name for a medication that is used solely for the purpose of reversing the effects of an opioid overdose. Naloxone has been approved for over-the-counter use since March 2023. The most common form is inhalable via a nasal spray.
The sole use of naloxone is to serve as an opioid antagonist. Simply, naloxone unblocks the brain’s opioid receptors that are overloaded when large concentrations of opioids are ingested or inhaled. When the opioid receptors become blocked, breathing can slow to a dangerously low rate of respiration. The brain is then deprived of oxygen, and brain injury can occur. Without prompt intervention with an opioid overdose reversal medication, an overdose can lead to death.
Naloxone only works on opioids and will not work on any other substances. Naloxone is harmless if it is used on someone who is not experiencing the effects of an opioid overdose.
The effects of naloxone will only last between 30 and 90 minutes, and it is possible for a person to have enough opioids remaining in their bloodstream after being revived from an overdose to experience the recurrence of overdose symptoms. This is why it is vitally important for individuals to be transported to a health-care facility for medical supervision after naloxone is administered.
Naloxone for Workplace Emergency Response
Two long-term AWCI members, Performance Contracting Group (PCG) and Valley Interior Systems, completed naloxone distribution and training in 2025. Both companies did so to protect the safety of the workforce on their shared worksites and to educate their workers on opioid safety.
Leadership from both companies agreed that stocking naloxone reinforces a culture of safety across their many large-scale project sites. Mike Hill, vice president of national safety for PCG, asserts that their responsibility extends beyond the immediate job site. “Safety does not stop with the scope of the work we perform,” Hill says. “By placing naloxone on our sites, we are demonstrating care for our workforce and the communities we serve. It’s a simple, responsible action that can save a life.”
For Hill, the decision is a direct reflection of PCG’s core values, fostering an environment where being equipped—without judgment—builds trust. “You can’t say you believe in safety and saving lives, then leave out a proven lifesaving tool,” he explains. He notes that the turning point for the company was treating the opioid crisis with the same urgency as any other medical emergency. “We didn’t wait for cardiac incidents to adopt AEDs, and we won’t wait for an overdose. Naloxone is simply the next step in first-aid readiness.”
To improve the flow, I’ve smoothed out the transitions between the personal anecdotes and the broader industry impact. I also consolidated the quotes to prevent the “he said/he stated” repetition.
Chris Sanders, vice president of safety for Valley Interior Systems, has seen a similarly positive shift in culture since stocking naloxone. He notes that honest conversations have been the key to moving the dial on employee understanding. “Initially, one supervisor was 100% against this,” Sanders recalls. “However, after we compared it to keeping AEDs and first-aid kits on-site ‘just in case,’ he completely supported the program.”
This shift in perspective has also heightened the company’s awareness of prescription risks. Sanders highlights a recent example where an injured worker required treatment: “When no alternatives to opioids were available, we requested that the medical team educate the employee and their family about the dangers of overuse. The doctors, nurses, and the family all appreciated that guidance.”
The impact of this leadership has resonated far beyond Valley’s own payroll. General contractors have been overwhelmingly supportive, often taking the initiative back to their own leadership, while specialty contractors have begun seeking advice on how to implement similar programs. Ultimately, Sanders believes that prioritizing this level of care has “strengthened relationships across the board.”
Conclusion
Safety and operational professionals are encouraged to increasingly focus on the prevention and medical case management of MSK injuries to reduce the prevalence of pain and decrease the risk of opioid pain management among injured workers. All construction leaders are encouraged to recognize the risk of opioid overdose is real in the industry. Naloxone has been a game changer in combatting the nation’s ongoing opioid crisis.
Stocking naloxone and providing the training to administer it is a proven strategy to help save lives. By equipping workplaces and jobsites with naloxone, more people can be trained to recognize the signs of an overdose and respond quickly in an overdose emergency.
Leading companies recognize the importance of being prepared to be response ready in case of an opioid overdose. The availability of naloxone and trained project safety leaders significantly reduces the risk of overdose fatalities—one company, one workplace, and one jobsite at a time. CD
Cal Beyer, CWP, NAC is senior director for SAFE Workplaces for national nonprofit SAFE Project. SAFE stands for Stop the Addiction Fatality Epidemic. Beyer has more than 30 years of construction risk management, safety and well-being experience. Contact Beyer at [email protected] or via cell at 651-307-7883. www.safeproject.us.
Recommended Reading and Resources
Beyer C. (September/October 2024) Reversing Opioid Overdoses in Construction: A Jobsite Imperative. Building Profits. Construction Financial Management Association (CFMA).
Beyer C, Jones R, Newland B. (March/April 2022) Waging a Counterattack Against Opioids in the Workplace and at Home. Building Profits. Construction Financial Management Association (CFMA).
Centers for Disease Prevention and Control (CDC). (November 2024). Chronic Pain and High-Impact Chronic Pain in U.S. Adults, 2023.
Centers for Disease Prevention and Control (CDC). (August 22, 2023) Drug Overdose Mortality by Usual Occupation and Industry: 46 U.S. States and New York City, 2020. National Vital Statistics Reports.
Center for Construction Research and Training (CPWR). (November 2020) “Musculoskeletal Disorders and Opioid Prescription Use among U.S. Construction Workers.”
National Council on Compensation Insurance. (June 8, 2020) Opioid Prescribing Across Industry Groups.
National Institute of Drug Abuse (NIDA) and National Institutes of Health (NIH). Opioid Management Guidelines for the Construction Trades. (Grant 1R34DA050044-01).
Texas A&M University. (October 3, 2024) Vital Record. Construction workers experience more injuries—and pain—than most other workers, and relief can be difficult to find.
