On-the-jobinjuries are common in construction, and many workers begin theiraddiction with a prescription intended to help get them back towork. (Image: Shutterstock)

PORTLAND, Ore. — JimmySullivan prepared for his job as a bricklayer the same way everymorning for years: injecting a shot of heroin before leaving his car.

The first time he overdosed on the job, in 2013 at a Virginiaconstruction site, a co-worker who is his cousin stealthilyinjected a dose of Narcan, an opioid antidote, into Sullivan's leg.He woke up and went straight back to work.

The second time, in 2014, his cousin revived him again, andafter resting for an hour in his car, Sullivan was back on the job.His boss told him not to let it happen again. But within a month,Sullivan had again overdosed on the job site. This time, anotherworker called 911. After a few hours at the hospital, he went backto work.

Related: Baby boomers in pain among ranks of opioidaddicts

As the opioid epidemic continues to rage across the country,with a record 72,000 drug overdose deaths estimated in 2017, thefallout is increasingly manifesting itself at construction sites,factories, warehouses, offices and other workplaces. A stunning 70percent of employers reported thattheir businesses had been affected by prescription drug abuse,including absenteeism, positive drug tests, injuries, accidents andoverdoses, according to a 2017 survey by the NationalSafety Council, a research and advocacy organization.

At least 217 workers died from an unintentional drug or alcoholoverdose while at work in 2016, up 32 percent from 2015, accordingto the Bureau of LaborStatistics. Workplace overdose deaths have been increasing by25 percent or more a year since 2010. Those numbers don't includethe many more overdoses that don't end in death, like Sullivan's,or accidents caused primarily or partly by drug impairment.

Incident reports from the Occupational Safety and HealthAdministration paint a grim national picture of workplace overdosedeaths: a mechanic at a Fiat Chrysler Automobiles plant inMichigan, a construction worker on a barge in Rhode Island, acrawfish fisherman in Louisiana and a Sam's Club worker who diedwhile stocking shelves in a Texas warehouse.

But despite the growing problem, many employers have turned ablind eye to addiction within their workforce, ill-equipped orunwilling to confront a complicated issue they do not know how toaddress, according to researchers and business executives.

The National Safety Council survey, which was based oninterviews with 501 managers at businesses with 50 or moreemployees, found that fewer than 1 in 5 companies felt extremelywell-prepared to combat the opioid crisis. Just 13 percent werevery confident they could identify risky use. And a little morethan half said they screened all employees for drugs, but 40percent of those had failed to screen for synthetic opioids likeoxycodone and fentanyl.

“Employers have been asleep at the wheel,” said Dave Chase,co-founder of Health Rosetta, a company that certifies employerhealth benefits, and author of “The Opioid Crisis Wake-Up Call.”Some companies are “key, unwitting enablers,” he added.

It is not that businesses are unaware of the toll the crisis istaking. Large employers spent $2.6 billion on treating opioid abuseand overdoses in 2016, up from $300 million 12 years earlier,according to the Peterson-KaiserHealth System Tracker. Those numbers do not include the cost oflost productivity. Workers who misuse pain medication miss anaverage of 29 days ayear, compared with 10½ days for other employees.

Yet, many managers are unwilling to acknowledge drug use attheir businesses.

“If you ask them if they believe they have an opioid problemwithin their population, a very high percentage of them would say,'No, we don't,'” said Pat Sullivan, executive vice president ofemployee benefits at Hylant, a large insurance broker in Indianathat manages benefit plans for more than 19,000 businesses. “Andyet we have access to prescription reports that are absolutelytelling me there's abuse happening” among their workers.

Pain comes with the job

Jimmy Sullivan, now 39, is slender and serious. He wears a heavysilver cross around his neck and has a half-finished tattoo of twobarracudas, teeth gnashing, on his arm.

A bricklayer for more than two decades, he is proud of hisskills. “I love my job. All over the city I drive around and say,'Hey, I built that,'” he said over lunch in Portland, where he grewup and now lives. “It's really tough work and not too many peoplecan do it.”

The construction industry has the second-highestrate of pain medication and opioid misuse after theentertainment, recreation and food business. About 1.3 percent ofconstruction workers are thought to be addicted to opioids, ornearly twice the addiction rate for all working adults, accordingto data from the 2012-14 National Survey on Drug Use andHealth.

Construction workers had the highest proportion of heroin- andmethadone-related overdose deaths from 2007 to 2012, according tothe Centersfor Disease Control and Prevention. InMassachusetts, arecent report found that 1 in 4 opioid deaths involvedconstruction workers.

On-the-job injuries are common in that industry, and manyworkers begin their addiction with a prescription intended to helpget them back to work. In 2016, twoin five workers' compensation claims for prescriptionsincluded an opioid. Laborers tend to come and go on job sites,meaning employers often don't know much about their workers.

Sullivan said he worked nonstop as a bricklayer in Portlandduring the 2000s, despite a serious drug habit — in those days,crystal meth. By 2011, he was a father of three girls and often sostrung out that he didn't recognize himself.

Alarmed by his descent, he moved across the country to NewportNews, Va., where he would be far from his dealers and drug-usingfriends. Though he readily found a job in Virginia, he also quicklygot hooked — this time to opioids. That part of the country wasawash in cheap heroin, which he augmented with Dilaudid, asemi-synthetic opioid prescribed by a doctor for back pain.

He's certain that several of his employers knew he was using,but they seemed not to care as long as he didn't get caught. “I wasso productive that a lot of crews just swept it under the rug,” hesaid. His employers did not respond to requests for comment.

At times he contemplated going into rehab at the suggestion ofhis family, but he did not seek treatment.

Employer intervention

Sullivan said no employer asked him to take a drug test, eventhough he had a criminal history that included arrests for drugpossession and distribution in Portland.

It was an open secret on job sites that many workers were usingdrugs, he said. They were the ones who disappeared for longlunches, isolated themselves and occasionally nodded off. “If youdrug-tested everyone, you wouldn't find many people to work withyou,” Sullivan said.

In theory, employers are in a unique position to confront opioidmisuse, through random testing and spotting erratic behavior orabsenteeism, said Chase, the author of “The Opioid Crisis Wake-UpCall.” They could change their health insurance policies to limitopioid prescriptions to five days and waive deductibles foraddiction treatment — an option that is often not available toconstruction firms because they typically do not provide healthinsurance.

But many employers have been slow to act.

On-the-job injuries are common in construction, and many workersbegin their addiction with a prescription intended to help get themback to work.

The Nord Family Foundation, a charity in northern Ohio, hostedan event in May in Elyria, near Cleveland, that was designed toteach employers how to identify and treat employees with substanceuse problems. Dr. Donald Sheldon, a trustee at the foundationand a former hospital president, advertised in local newspapers andreserved a room at the local community college that would seat200.

Just 30 people showed up, he said.

Of the 10 companies whose employees' suspected opioid overdosedeaths were detailed in OSHA reports since 2014, most did notrespond or refused to address specific incidents.

Sam's Club, a division of Walmart, said in a statement that itprovided mental health and substance abuse coverage to employeesand offered an employee assistance program. Fiat Chrysler said inan email that it had adopted more stringent opioid prescribingguidelines in its health plan and supported the use ofmedication-assisted addiction treatment.

Just one employer, Giovanna Painting in Spencerport, N.Y.,agreed to an interview. Alan Hart, the company's president, said hewas shocked when one of his employees was discovered dead from aheroin overdose in a port-a-potty on a job site in 2017.

A recovered addict himself, Hart said he tries to be sympatheticand help workers get into rehab, though he does not provide healthinsurance.

“We're much, much stricter now,” since the 2017 overdose death,he said. “We're doing a lot more drug testing. I'm on the sites agreat deal more. I'm walking and talking, and I pull the guys asideand look in their eyes.”

This summer, Hart fired 12 of his 50 employees for suspecteddrug abuse. It pained him to do it, he said, and it was difficultto lose so many workers in his busiest season. But he said the riskof keeping someone on who was using drugs was too high.

The Association of Union Constructors recently devotedthe springissue of its magazine to the opioid epidemic. The groupsays an increasing number of union contractors provide naloxone,the opioid antidote, on job sites.

Clusters of tents line the streets of downtown Portland.

A lifesaving union benefit

After his third overdose on the job for the same contractor inVirginia, Sullivan was fired. In 2015, he returned to Portland,which was in the throes of its own heroin crisis. Amid clusters ofhomeless encampments that dot downtown Portland, users can bespotted leaning against buildings, heads nodding back, needles inarms.

Back in his hometown, enticed by union retirement benefits,Sullivan joined the Bricklayers and Allied Craftworkers Local 1,Oregon, in 2016, which turned out to be a turning point forhim.

Shortly after he joined the union, Sullivan was laid off forerratic behavior and his local learned he was abusing drugs. Butunlike his previous employers, the union had a plan to get him backto work.

Having seen many of its members struggle with addiction,officials at the International Union of Bricklayers and AlliedCraftworkers had over several years come up with a suite ofprograms to prevent substance abuse, to identify affected workersand to steer them into treatment.

This year, labor leaders at the North America's Building TradeUnions (NABTU), a coalition of 14 unions in the building trades,set up a task force to address the opioid crisis. “We're all facingalmost the same identical problem,” said Karen Grear, who runs themember assistance program for the bricklayers union.

At a recent presentation to local union chiefs, Grear askedwhether anyone had lost a member to opioids. Three-quarters of theparticipants raised their hands. One reported that five apprenticeshad died in the past few months.

In Portland, Matthew Eleazer, the president of Sullivan's local,said at least 10 of his approximately 650 members had recentlystruggled with opioid use disorders, some with lethal outcomes. Onewas a single father prescribed opioids for a back injury whoaccidentally took too many pills. Another was a promising youngapprentice found by the side of the road with a needle in his armon his way to a wedding.

Eleazer said the union tests all members when they join andrandomly after that; he often gets reports from employers when amember doesn't show up for work or is repeatedly tardy.

At a time of labor shortage, he said, contractors have mostlyadopted a don't-ask-don't-tell attitude. “They just want guys toput material on the walls,” Eleazer said. “They just want thebuilding to go up.”

The union told Sullivan he could return to work if he went intorehab, but there was a problem: He had an arrest warrant out forviolating parole from a prior arrest, and the treatment centerswould not accept him until he served his jail term.

Sullivan was unwilling to go to jail and disappeared. Unionofficials tracked him down and called the police to arrest him whenhe was passed out in his car. The union persuaded a parole officerwho helped convince a judge to let him serve his time at a drugtreatment facility instead of jail, and union representativescalled him several times a week.

As promised, they found him a job when he was released in 2017,but this year he was laid off at the end of a construction projectand relapsed again. Weeks later, Sullivan called to say he wasliving in his two-door Honda, claiming to have been clean for acouple of weeks.

“Do you remember what I told you to do when you were in thatsituation? That I was your first phone call?” Mike Titus, a unionofficial, said to him when they met up at a bar. “Could you pass adrug test right now?”

If so, the union had a job for him and he could shower at theunion hall, until he arranged for a home. “Matt and Mike were thefirst ones who cared enough,” said Sullivan. “None of my employersgave a shit enough to even ask.”

A month later, Mr. Sullivan was back to work on a union job,living in a new home and sober once again.

Kaiser Health News is anonprofit news service covering health issues. It is an editoriallyindependent program of the Kaiser Family Foundation, which is notaffiliated with Kaiser Permanente.

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