Bombshell Ontario report details construction worker overdoses

Key Takeaways:

• Ontario construction workers made up nearly 8 per cent of Ontario’s overdose deaths between 2018 and 2020.
• Researchers found that these workers often were young, male and using non-prescription drugs alone.
• The report also found that nearly 80 per cent of workers who died had recently had a pain-related injury.

The Whole Story:

Ontario construction workers are being disproportionately impacted by non-prescription drug overdoses, a new report shows. 

The report, which was released this summer, found that close to 1 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.

The research was conducted by experts from the Ontario Drug Policy Research Network (ODPRN) at St. Michael’s Hospital, ICES, the Office of the Chief Coroner for Ontario and Public Health Ontario.

Unregulated drugs

The report shows deaths among construction workers are primarily being driven by the unregulated drug supply rather than pharmaceutical opioids prescribed for pain.

Researchers found that cocaine and alcohol were more commonly involved in opioid toxicity deaths among construction workers when compared to those not working in the construction industry.

“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 and a principal investigator for 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.”

Gomes suggested that 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.

428 workers lost

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 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. Researchers noted that previous reports have shown 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 dug into the circumstances surrounding the deaths and found:

They found that fentanyl and cocaine involvement were significantly higher among those with construction work backgrounds 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

Using alone

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 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.

Breaking down the demographics

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 reports authors called for industry-level response in the construction industry that recognizes the stigma around drug use, which may make people less likely to engage in treatment and harm reduction services offered through their employer.

The researchers added that the response should included a plan to naloxone access at home, raised awareness about drug use safety, and low-barrier access to evidence-based treatment. This includes 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,” said Dr. Dirk Huyer, chief coroner for Ontario. “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.”