Opioid Use and Mental Health in the Construction Industry: The Importance of Workplace Supports

Mental Health Concerns

Mental health is a growing concern in the construction industry. One study found the prevalence of mental health conditions among construction workers was as high as 30% (PDF). Above all other industries, the rate of death by suicide is highest among males working in construction trades. According to a U.S. Centers for Disease Control and Prevention (CDC) analysis of 2021 death reports, 56 out of every 100,000 male construction workers die by suicide, compared to a national average of 32.

Substance Use Disorder and Opioid Misuse

People using opioids are more likely to report mental health conditions, and substance use is also correlated to increased rates of death by suicide. Substance use disorder refers to the recurrent use of alcohol and/or drugs that cause clinically significant impairment. Opioid misuse refers to the use of prescription opioids in any way other than as directed by a healthcare provider.

Opioid Use in the Construction Industry

Construction work is physically demanding and often includes tasks with high injury and illness rates. The injury rate for construction workers is 77% higher than the national average (PDF). Age, race, class, and gender can make some workers more vulnerable to workplace injury than others. To manage the pain from frequent injuries, construction workers are prescribed opioids at higher rates (PDF) than workers in other occupational categories. Construction workers prescribed opioids for pain have a higher risk for long-term opioid use and for developing opioid use disorder. Their working conditions, the cultural and social contexts of their work, and their membership in historically marginalized communities with lack of access to treatment are associated with higher risk.

Ninety percent of construction companies have fewer than 20 employees (PDF). Workers from very small companies such as these are prescribed opioids more frequently (PDF) than larger ones, and small businesses tend to be less equipped to manage opioid use (PDF). Compared to larger companies, small businesses often have fewer resources dedicated to opioid education, awareness, tracking, and testing. Larger businesses are better equipped to provide employee assistance programs (EAPs) and initiatives dedicated specifically to opioid use.

The Center for Construction Research and Training (CPWR) is working with the construction industry to understand and address this problem. Their research found that 10% of construction workers used opioid pain medication (PDF) and those with work-related injuries were nearly four times as likely to use opioids. Medications prescribed to control pain for work-related injuries are sometimes misused, and approximately 15% of workers who are prescribed opioids become long-time users. Cultural factors such as an expectation to work through pain, stigma around seeking mental health treatment, and a historically male-dominated field with fewer discussions around self-care can also enable substance misuse problems in the workplace. The Center also found that the death rate due to opioid overdose is six to seven times higher in the construction trades than in any other industries.

To address this, the Center brought together a group of experts on workplace safety, mental health, and substance use for a workshop on preventing overdose and suicide (PDF) among construction workers. The group worked to create a strategic roadmap to address the high rates of suicide and overdose deaths in the industry by mapping out known issues and establishing working groups in four key thematic areas. Participants recommended a multi-pronged approach to address substance use disorder. It includes education and training, culture change, injury prevention, peer support, and established task forces for each area to conduct further research.

In the construction industry, employers, workers, and industry organizations all have a role to play in creating a safe working environment. A comprehensive plan to address substance use disorder should include strategies to address broader workplace mental health and wellness. Construction industry employers can help limit and address opioid misuse through policies and programs that promote safer workplaces, opioid awareness, and mental health education and support.

Workplace Safety and Prevention

The CDC’s National Institute for Occupational Safety and Health (NIOSH) Opioid Framework describes risk factors for opioid misuse and identifies workplace policies that affect workers. The Framework identifies work-related illness or injury as a key risk factor. 

To reduce or eliminate occupational hazards that may lead to opioid use:

Workplace policies that promote healthy recovery: 

Removing and reducing risks can prevent injuries that lead to opioid use and misuse. Treatment and support options allow employees to get the care they need and stay in their roles.

Education and Support

Construction firms can educate managers and workers (PDF) on the dangers of opioid misuse, especially after workplace injuries. They should also ensure everyone can access support and services without fear of stigma or job loss. Employers can:

Strategies that support mentally healthy workplaces, such as those in EARN’s Mental Health Toolkit, promote a work environment that is “recovery-ready.” These strategies help employers promote awareness of opioid misuse and mental health, provide accommodations if needed, and ensure workers have access to treatment.

Resources

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