Workers Overdose On The Job, And Employers Struggle To Respond

By Jenny Gold, who covers the health care industry, the ACA and health care disparities for Kaiser Health News. Her stories have aired on NPR and been published by USA TODAY, The Washington Post and many other news organizations. Originally published at Kaiser Health News

Despite the growing epidemic of Americans misusing opioids and overdosing on the job, many employers turn a blind eye to addiction within their workforce — ill-equipped or unwilling to confront an issue they are at a loss to handle.

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

The first time he overdosed on the job, in 2013 at a Virginia construction site, a co-worker who is his cousin stealthily injected 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, and after 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, another worker called 911. After a few hours at the hospital, he went back to work.

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

At least 217 workers died from an unintentional drug or alcohol overdose while at work in 2016, up 32 percent from 2015, according to the Bureau of Labor Statistics. Workplace overdose deaths have been increasing by 25 percent or more a year since 2010. Those numbers don’t include the 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 Health Administration paint a grim national picture of workplace overdose deaths: a mechanic at a Fiat Chrysler Automobiles plant in Michigan, a construction worker on a barge in Rhode Island, a crawfish fisherman in Louisiana and a Sam’s Club worker who died while stocking shelves in a Texas warehouse.

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

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

“Employers have been asleep at the wheel,” said Dave Chase, co-founder of Health Rosetta, a company that certifies employer health 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 is taking. Large employers spent $2.6 billion on treating opioid abuse and overdoses in 2016, up from $300 million 12 years earlier, according to the Peterson-Kaiser Health System Tracker. Those numbers do not include the cost of lost productivity. Workers who misuse pain medication miss an average of 29 days a year, compared with 10½ days for other employees.

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

“If you ask them if they believe they have an opioid problem within their population, a very high percentage of them would say, ‘No, we don’t,’” said Pat Sullivan, executive vice president of employee benefits at Hylant, a large insurance broker in Indiana that manages benefit plans for more than 19,000 businesses. “And yet we have access to prescription reports that are absolutely telling me there’s abuse happening” among their workers.

Pain Comes With The Job

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

A bricklayer for more than two decades, he is proud of his skills. “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 grew up and now lives. “It’s really tough work and not too many people can do it.”

The construction industry has the second-highest rate of pain medication and opioid misuse after the entertainment, recreation and food business. About 1.3 percent of construction workers are thought to be addicted to opioids, or nearly twice the addiction rate for all working adults, according to data from the 2012-14 National Survey on Drug Use and Health.

Construction workers had the highest proportion of heroin- and methadone-related overdose deaths from 2007 to 2012, according to the Centers for Disease Control and Prevention. In Massachusetts, a recent report found that 1 in 4 opioid deaths involved construction workers.

On-the-job injuries are common in that industry, and many workers begin their addiction with a prescription intended to help get them back to work. In 2016, two in five workers’ compensation claims for prescriptions included 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 Portland during the 2000s, despite a serious drug habit — in those days, crystal meth. By 2011, he was a father of three girls and often so strung out that he didn’t recognize himself.

Alarmed by his descent, he moved across the country to Newport News, Va., where he would be far from his dealers and drug-using friends. Though he readily found a job in Virginia, he also quickly got hooked — this time to opioids. That part of the country was awash in cheap heroin, which he augmented with Dilaudid, a semi-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 was so productive that a lot of crews just swept it under the rug,” he said. His employers did not respond to requests for comment.

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

Employer Intervention

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

It was an open secret on job sites that many workers were using drugs, he said. They were the ones who disappeared for long lunches, isolated themselves and occasionally nodded off. “If you drug-tested everyone, you wouldn’t find many people to work with you,” Sullivan said.

In theory, employers are in a unique position to confront opioid misuse, through random testing and spotting erratic behavior or absenteeism, said Chase, the author of “The Opioid Crisis Wake-Up Call.” They could change their health insurance policies to limit opioid prescriptions to five days and waive deductibles for addiction treatment — an option that is often not available to construction firms because they typically do not provide health insurance.

But many employers have been slow to act.

The Nord Family Foundation, a charity in northern Ohio, hosted an event in May in Elyria, near Cleveland, that was designed to teach employers how to identify and treat employees with substance use problems. Dr. Donald Sheldon, a trustee at the foundation and a former hospital president, advertised in local newspapers and reserved a room at the local community college that would seat 200.

Just 30 people showed up, he said.

Of the 10 companies whose employees’ suspected opioid overdose deaths were detailed in OSHA reports since 2014, most did not respond or refused to address specific incidents.

Sam’s Club, a division of Walmart, said in a statement that it provided mental health and substance abuse coverage to employees and offered an employee assistance program. Fiat Chrysler said in an email that it had adopted more stringent opioid prescribing guidelines in its health plan and supported the use of medication-assisted addiction treatment.

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

A recovered addict himself, Hart said he tries to be sympathetic and help workers get into rehab, though he does not provide health insurance.

“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 a great deal more. I’m walking and talking, and I pull the guys aside and look in their eyes.”

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

The Association of Union Constructors recently devoted the spring issue of its magazine to the opioid epidemic. The group says an increasing number of union contractors provide naloxone, the opioid antidote, on job sites.

A Lifesaving Union Benefit

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

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 for him.

Shortly after he joined the union, Sullivan was laid off for erratic behavior and his local learned he was abusing drugs. But unlike his previous employers, the union had a plan to get him back to work.

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

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

At a recent presentation to local union chiefs, Grear asked whether anyone had lost a member to opioids. Three-quarters of the participants raised their hands. One reported that five apprentices had 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 recently struggled with opioid use disorders, some with lethal outcomes. One was a single father prescribed opioids for a back injury who accidentally took too many pills. Another was a promising young apprentice found by the side of the road with a needle in his arm on his way to a wedding.

Eleazer said the union tests all members when they join and randomly after that; he often gets reports from employers when a member doesn’t show up for work or is repeatedly tardy.

At a time of labor shortage, he said, contractors have mostly adopted a don’t-ask-don’t-tell attitude. “They just want guys to put material on the walls,” Eleazer said. “They just want the building to go up.”

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

Sullivan was unwilling to go to jail and disappeared. Union officials tracked him down and called the police to arrest him when he was passed out in his car. The union persuaded a parole officer who helped convince a judge to let him serve his time at a drug treatment facility instead of jail, and union representatives called 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 project and relapsed again. Weeks later, Sullivan called to say he was living in his two-door Honda, claiming to have been clean for a couple of weeks.

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

If so, the union had a job for him and he could shower at the union hall, until he arranged for a home. “Matt and Mike were the first ones who cared enough,” said Sullivan. “None of my employers gave 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.

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  1. Steve H.

    So now there’s a problem?

    Note the reference to meth; I have known multiple workers in construction over the course of decades who have used, on the job. Particularly when groups went out of town and someone was paying for lodging. Meth increases productivity, helps them work all night long, increases their work rate when only minimal standards need to be reached. In at least one group of about a half-dozen, they guy who didn’t use was the outlier.

    It was sometime about a decade+ ago when meth overtook weed as the most abused drug, and it wasn’t all hard-cases, I remember a sorority girl quoted for being able to power-clean. Now that the obvious abuse is a drug that lowers productivity, we’re hearing about it. Don’t-ask-don’t-tell ain’t nothin knew.

    As to the shift to opioids, all I’ll note is that deaths from heroin had flatlined until post-Lehman. It was prescribed opiates that had a steady rise, but post-crash it’s heroin and analogues that have spiked.

    1. Ronald Wilkinson

      I found doing cocaine helped you remain productive when smoking weed. It was enjoyable working as a carpenter working in that condition. If you were piece working you could make enough to offset the cost of coke.

      1. Jonathan Holland Becnel

        I used to smoke crack and deliver pizzas for Mellow Mushroom.

        30 mins or less?

        Fuck MORE LIKE 15!

        And id say its 75% weed 25% coke/meth in the French Quarter.

  2. Chris

    I’ve worked in and around construction trades for the past 20 years as an engineer. It has always been a problem to get enough people on the site who can piss clean. That’s true even for high end sites with clearance requirements and background checks like nuclear jobs or DOD/DOE work.

    The problems with drinking and drugs and other issues (cellphone use when working on elevated platforms) have become much worse in the last 6 years. It’s hard work. It’s good work. It pays well too. This is a tragedy and a real problem we need to address as a society.

    1. Ronald Wilkinson

      When I started working on the housing tracts back in the 70s alcohol and drugs were endemic to the job. Methedrine was sold in small pill form call mini-meth tabs or cross tops and pot was common. Later on, if you made good money cocaine came in the mix. When I first started in the trade (carpenter) I knew a few heroin addicts, not many but a few. I befriended someone who was trying to kick and was on methadone.
      So meth was performance enhancing, so was cocaine. Drinking occurred on the job, at lunch and for sure after work. A beer in your crotch and a joint in hand while driving home was where it was at!

  3. Michael Fiorillo

    “… Sullivan joined the Bricklayers and Allied Craftworkers Local 1… a turning point for him.”

    Work union, live better (and continue living, period). If only other workers realized the same, and if only we had a Democratic Party that believed likewise.

  4. Larry

    I’ll admit to being at odds with the employer helping out here. I’m opposed to employer drug testing at all levels. I appreciate the one employer who took to walking the job sites to see who is working steady and who might have a problem. I understand that drug testing is the right of the employer, but I feel like management can tell who is a problem and who isn’t without testing.

    1. Chris

      I respectfully disagree. In the construction trades, the potential for causing harm to others and property is very high if you are impaired. It is absolutely the employer’s responsibility to do whatever they can to make sure that everyone who comes to work is not a risk to those around them. Most of their insurance policies require something like this in order to keep costs reasonable for a project.

      Depending on the nature of the project, and the location of the work site, management may not be able to directly observe their workers. For example, in dangerous locations, confined spaces, or hot work areas, hazardous sites, etc. the goal is to minimize exposure to the public. Extra bodies get in the way and create additional hazards for the workers. Also, if it’s 24/7 shift work, there may not be enough opportunities to observe an employee when they are working to catch a problem employee before they cause an issue.

      There is a huge difference between the training and performance expectations for a construction worker or skilled tradesperson compared to a typical office employee. Perhaps because so few people are engaged in this work many don’t have an appreciation for that.

      1. Larry

        That’s all well and good, but it’s not like workers pee into a cup every single day and have a drug test daily. The reality is people can perform poorly in all kinds of critical roles without draconian drug testing. How for instance would you diagnose an employee suffering from insomnia or depression who might cause a serious problem at a critical job? Management and a culture among workers that value and prize safety overall. Drug testing cannot create that. If anything, the drug testing creates a false sense of security or limits liability for management and/or ownership when/if something goes wrong.

        1. Chris

          Actually…in some cases, they do. And on most sites with clearance requirements, if they were involved in any on the job incident or accident immediate drug testing is mandatory.

          There’s been a lot of good work to build the kind of safety culture you’re talking about at all levels of the construction business. Especially for the higher end and government work. There’s also fatigue mange management policies which have been developed to help tradespeople in key positions to keep themselves in a safe/fit condition.

          But even in those cases, even in the really great sites I’ve been on where everyone was religious about safety, you were always drug tested. At least 3 times. Once when you were processing to come on the site, once in the middle of job (randomly), and usually at exit too. If you were observed to behave erratically, someone would usually request another test. If you were called for a special request, as in you were off the clock and and an emergency happened and they needed you on site, you were required to confirm if your BAC was above the site limit and you’d usually be asked to take a test when you arrived on shift the next day.

          So we’d get these guys, really hard working people, who would get through this process to get on site and be promised good money as welders, carpenters, etc. But they couldn’t piss clean. So they’d be booted off site. Sometimes before their first paycheck had cleared.

  5. Jerry B

    I had a 25 year career in plastics engineering with most of my time being in plastics injection molding. I can say that when working in manufacturing in the mid 90’s and earlier I saw employers/companies that expected “a reasonable hard days work for a days pay”. But since then employers want blood and treat their employees and their bodies as disposable commodities. I believe the advent of neoliberalism in the late 70’s and the change from stakeholders to stockholders is one major factor. I remember working for Baxter Healthcare in the late 80’s and being laid off and the director of our R&D group saying he was afraid the economy and society were becoming a short term quarter to quarter economy society.

    Another factor is since the entry of China and others into world trade i.e globalization in the late 90’s/early 2000’s employers have become sadistic in their treatment of employees. I think some of this is due to cost pressure companies face in competing in a global market. But I have seen poor worker treatment in white collar jobs as well. I have also heard of local appliance repair companies that run their workers into the ground expecting 12+ hour days. Many factory employees now work twelve hour days. Many nurses now work twelve hour days. And many people work 2nd shift or 3rd shift. And we have a drug epidemic in society??? Not a surprise.

    So I am not shocked that their is a opioid epidemic. If I was still working in plastics injection molding I am sure I would need to take Vicodin every day to survive.

    However alluding to Chris’s comment above I also think there is a societal element as well and it is related to social capital and the moral and ethical fabric of our society. In my last job in manufacturing I remember the owner of the company saying it was hard to find factory employees who did not have some sort of criminal record mostly for drugs.

    I am not a fan of Charles Murray but in Coming Apart he mentioned this type of two class splitting between the professional and lower classes with the lower classes beset by societal ills such as divorce, job loss, etc. I just don’t agree that with his conclusion that it is due to the society becoming more complex and the “intellectual elites” separating themselves. A load of crap. I have known a lot of PHD’s who are as obtuse as they come and I have known a trades people who are brilliant. As Lambert, Thomas Frank and others have written extensively it is the credentialed, meritocratic, moneyed, and gilded elites like Marcie Frost parading themselves as intellectual elites when they are just frauds. It is a income class issue and the lower half of the inequality spectrum has had the rug pulled out from under them by the elites and Corporate America.

    For those of you who are not fans of Charles Murray, George Packer wrote of similar theme in his book, The Unwinding. And obviously there was Robert Putnam in Bowling Alone.

    The neuroscientist Jaak Panksepp has written about opioids and love, loneliness, and social bonds in his book Affective Neuroscience i,e. we are taking something synthetically (opioids) to get the same feeling that we used to get from our social bonds and communities:

    Lastly Chris Hedges current article in TruthDig which discusses Emile Durkheim’s book, On Suicide, sums it up:

    And we wonder why we have as Angus Deaton and Anne Case have stated “deaths of despair”.


    What I want to know if, how many of these employers would’ve fired the addicted employees on the spot if instead of opioids, they tested positive for marijuana?

  7. orange cats

    The problem I have with articles like these with their focus on employers, drug companies, doctors, cops doing their part is that it stops short, critically. It’s “you got a problem, go to rehab” when the ONLY effective treatment for opioid addiction so far is medication based, which is resisted and often condemned. So, we get better at identifying/nabbing the addicts, send them off on a spin cycle of shamefully incompetent, avaricious rehabs– most of them simply rackets, the rest shambolic failures. How is this a solution or even progress?

  8. just the thorn

    Can’t get behind the premise that this is business/management problem, except insofar as the companies are contributing to poor work safety standards etc that lead to the work injury and opioid prescription in the first place. At least this piece covers the unions actually doing good work to support their workers. Kudos to them. We should be looking out for each other and trying to help solve the root problems, not pushing for people to get fired from their jobs for using and giving up on them.

  9. savedbyirony

    Your comment reminded me of this tragic story to demonstrate what you are saying about “rehabs”:

    I think the above also demonstrates the false sense of security the upper middle class still harbors towards all these systemic social ills and crimes. Being “filthy rich” will give one protection, and all sorts of opportunities for even great wealth, but NO other class in the USA has either safety nets nor ordinary citizen agency and protection. (Also, if it can possibly get bleaker, was there not a recent article posted here about Purdue Pharm having the patent on certain meds intended for “treatment” of opioid addiction?)

    This society’s traps are insidious, insidious! It is like Hercules fighting the Hydra, except people in general are not gifted with extraordinary personal strength/resources. All it takes is one weakness in one’s life to arise and it becomes an ever draining battle of what will come next to face because in whatever direction one turns for paid service and/or help a new attack arises; and the attackers all have their root in the same beast.

    (reply to Orange Cats)

  10. Jonathan Holland Becnel

    This doesnt even cover the Restaurant Industry which im sure has the most Opioid abuse.

    For example:

    Landrys on the Lakefront in Lakeview, LA- saw a dude on Heroin getting a fountain soda as hes ‘ducking’ aka falling asleep while standing up.

    -saw a bartender all fd on pills try to hand me my beer for a customer and she straight up dropped it and spilled it an inch from my hand. She didnt acknowledge me or anything.

    This doesn’t even cover the alcoholism raging in kitchens and on the floor. I got fired from this Mexican Restaurant called Serranos in Baton Rouge after i jacked a bottle of Patron, drank it, and then proceeded to play air guitar on our stage. With the Band.
    Funniest part was the fact that i blacked the entire night out AND SHOWED UP EARLY THE NEXT DAY. My manager was not pleased.


  11. H. Alexander Ivey

    Is the Overton window so tight now that drug use is not a social problem? This posting make drug use and death appear to (just) be a problem that business only is to solve.

  12. Newton Finn

    When workers are forced by relentless pressures and stresses to overdose ON THE JOB, then many workers will overdose on other things while doing the job.

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