https://www.thestar.com/news/gta/2022/05/04/nearly-1-in-3-employees-to-die-from-an-opioid-overdose-works-in-construction-is-the-industry-doing-enough-to-confront-the-crisis.html

The weekend before Ontario’s construction industry launched a campaign to combat fatal opioid use among its workers, two young apprentices in Toronto overdosed together. One didn’t survive.

The death of the young man, who was in his mid-20s, shook Mike Yorke’s world. As president of the Carpenters District Council of Ontario, Yorke had been lobbying hard to bring attention to what he called the “silent crisis”: In the first 10 months of the pandemic, 30 per cent of employed Ontarians who died from overdose worked in construction — the highest proportion of any industry.

“When a young man who is a second-term apprentice at our organization dies, it hurts the whole organization,” Yorke told the Star. “People are in tears, people are upset. It is shocking.”

“The Other Pandemic” campaign kicked off a few days later on May 31, 2021, spreading broad awareness on the stark impact of the opioid crisis on the construction industry through a website, news releases and media interviews. Among industry leaders and colleagues, the young man’s death was a reminder of the needed urgency to speak openly about mental health and addiction in the sector — topics that some say were once put on the back burner.

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. Last month, Ontario passed a law that mandates naloxone, a drug that can temporarily reverse the effects of opioid overdoses, be available at every construction site, among other workplaces known to see higher rates of opioid use, like bars and nightclubs. The kits are expected to roll out in the fall.

Many say the move is long overdue. But questions remain around whether it’s enough to meaningfully address opioid-related deaths in the industry, where use happens both on and off work sites, amid an overdose crisis that has boiled over in the face of the pandemic.

“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.”

Ontario’s data comes on the heels of a long-observed crisis in the United States: A New York University study in particular, which looked at numbers from 2005-2014, found that construction workers had a higher rate of misusing prescription opioids than any other line of work. This is supplemented by studies out of Ohio and Massachusetts that revealed construction workers were seven times more likely to die of opioid overdose than employees in other industries.

While data in the U.S. has been accessible for years, comparable numbers in Ontario were not available until 2019 when the Ontario Drug Policy Research Network released its opioid mortality report, which showed the rate of fatal overdoses among construction workers to be around 31 per cent of all Ontarians who died while employed. Their latest report in May 2021, which examines the first 10 months of the pandemic, found that rate has stayed consistent.

In Toronto, the acknowledgment of substance use in the trades dates back to the early 1990s, when UA Local 46, the union representing plumbers, steamfitters and welders, helped create an addictions treatment facility, called De Novo, specifically for members of the construction industry. It primarily focused on alcohol addiction, said Aaron Sinclair, its current executive director.

“It’s definitely changed over time,” Sinclair said, with more people seeking treatment for opioid use in the past 10 years, though an overwhelming majority are still being referred for alcohol or cocaine use. Sinclair said this has raised questions about possible gaps in treatment for opioids, which the facility hopes to address in coming surveys and research funded by the Ministry of Labour.

The 42-bed facility serves on average 500 people a year, all from the construction industry. It is entirely funded by union fees, with a membership of more than 80 trade unions across Ontario, amounting to 200,000 workers who have access to the facility.

This only makes up about half of the total construction workforce in Ontario, as industry organization BuildForce Canada estimates the province’s workforce to be around 413,600. Many of those are not unionized and are on contract, Sinclair said, meaning some may not have readily available access to treatment.

Sinclair said De Novo, since its inception, was able to promise immediate access to a bed. But that changed after the COVID-19 pandemic, during which the facility saw an increase of demand by up to 30 per cent, with a wait time of as much as 10 weeks at certain points in the past two years.

While the construction industry has grappled mainly with high rates of alcohol use in the past, Cristina Selva — the executive director of the College of Carpenters in Ontario, who has been involved with the industry for more than 35 years — agreed that opioid use has since grown.

“I think the reasons for substance abuse, regardless of whether it’s opioids or alcohol or marijuana, are all the same,” Selva said. 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.”

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.

Three years ago, Selva was confronted with a crisis in her own college after a staff member died by suicide. Shortly after, Selva introduced Mental Health First Aid training to other staff members. After the onset of the pandemic, the college also began offering a mental health course for students.

“It was filled immediately,” Selva said. “I think that’s evidence of the incredible need and desire for this type of training.”

Others elsewhere in the province have also taken matters into their own hands to spread mental health awareness in the industry. Among them is Mark Barnes, founder of a network of pharmacies in Ottawa, called Respect RX, that focus on serving those with mental health and substance use issues in a stigma-free environment.

Barnes has opened his pharmacies at 7:15 a.m. since their founding in 2013, partly so construction workers can have a chance to grab their prescriptions for opioid substitution therapy before heading to job sites, where they’d often work 12-hour days.

“We knew for years that this was a problem,” Barnes said.

Industry leaders said the pandemic has been a turning point for conversations on mental health, both outside the trades sector and within it. While the most recent and comprehensive Ontario data available on opioid deaths in the industry is from 2020, many signs point to an overall opioid crisis that has since worsened.

Last May — the month the two young apprentices overdosed — Toronto paramedics received 418 calls for non-fatal suspected opioid overdoses, an average of 13 a day. This is almost double the same period in 2020. An additional 36 calls in May were fatal, marking a significant spike of opioid deaths in the city at the time.

The country was also in the midst of a spike in deaths not seen since data collection began in 2016, with 5,368 people dying from opioids between January and September of 2021, compared to 4,679 deaths during that same period in 2020. A majority of these deaths, around 86 per cent, involved the powerful opioid fentanyl.

With this rise in fatal overdoses, many who work in mental health and harm reduction have been looking to policymakers. In an interview, Ontario Labour Minister Monte McNaughton said the spike in deaths is why he introduced legislation to mandate naloxone kits be available at construction sites. The legislation also requires there to be at least one person on site at all times who is trained in administering naloxone, McNaughton said.

“My belief is the more naloxone kits in people’s hands, the more lives we’re going to save.”

A Ministry of Labour spokesperson said the government is currently consulting with industry leaders on the rollout of the naloxone program, with an expected enforcement date in the fall.

For Sinclair of De Novo, the hope is that these 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.

“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.

But while naloxone kits are being rolled out on job sites, some experts say more should be done to reverse the higher rate of overdose deaths in the industry. Dr. Sereda, who runs the safer supply program in London, said that pre-pandemic, her program had enough capacity to help both acute patients and people in the construction industry whose opioid use was more moderate, and it did so with “excellent success.”

Since the 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.”

Nadine Yousif is a Toronto-based reporter for the Star covering mental health. Follow her on Twitter: @nadineyousif_