CLEVELAND, Ohio - Addiction recovery-themed hard hat stickers, carpenter's pencils and sports radio ads are a few of the tools public health workers in Massachusetts are using to reach those hardest hit by opioid overdose deaths there: trade workers.
Those initiatives might be of interest to officials in Ohio where construction trade workers also are at a higher risk to die from opioid overdoses.
The burgeoning effort in Massachusetts started in 2013, when health workers with the Mystic Valley Public Health Coalition noticed a pattern in the death logs kept in the towns where they worked.
Those who spent their careers in working class trades such as plumbers, pipefitters, electricians, carpenters and laborers were dying of opioid overdoses.
After collecting data on more than 300 fatal overdoses, the coalition found that trade workers accounted for 42 percent of the opioid-related deaths in six northern Boston suburbs.
Since then, a second group, this one in Barnstable County, which includes Cape Cod, found that construction workers made up 38 percent of the 281 opioid overdose deaths in that county from 2010 - 2014, even though construction trade and service workers made up only 14 percent of the workforce. Construction workers there are at more than 4 1/2 times greater risk on average to die of an opioid overdose than workers with other jobs.
A recent Plain Dealer analysis found that construction trade workers in Ohio were seven times more likely to die of an opioid overdose last year than other workers in the state. (The Massachusetts groups, though, used a wider definition for trades workers in their data analysis than The Plain Dealer.)
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To reverse the deadly trend, the Mystic Valley coalition set out to understand as much as they could about what was putting the trade workers at such a high risk.
"We were just trying to learn about this from every angle," Lauren Dustin, who works in Medford and coordinates her area Opioid Abuse Prevention Collaborative.
With support of a $100,000 state grant, the group surveyed trade workers, union leaders, employee assistance program providers, local occupational safety and substance abuse experts in the area.
Common themes soon emerged when asking why trade workers might be vulnerable to opioid abuse and death, including:
- Workers felt they could not take time off to heal from injuries.
- Workers said the often didn't report injuries and used narcotic medications to work through pain.
- Workers felt they'd lose their jobs if they sought help for addiction.
- Many felt they'd be labeled a "rat" if they reported someone else on the job using drugs.
One obstacle the group faced was coming up with an approach that would work in an industry that included union and non-union workers.
Some of the union workers in the area had local representation, benefits and employee assistance programs, others did not. The size of the companies also varied.
"Sometimes it's big company," Dustin said, "And sometimes it's small crews like Johnson & Sons Electricians with five people."
Multiple strategies
Massachusetts, like Ohio, has taken legal and regulatory steps to limit the amount and the dosage of narcotic pain medications doctors dole out to injured workers, in an effort to prevent the highly addictive drugs from being introduced to a new generation of workers.
But the public health workers needed to quickly address the alarming number of deaths, while building long-term support mechanisms for trade workers.
First the group created public service announcements that ran on two local sports radio stations, to get the message to job sites.
They asked a few tradesmen to read the proposed scripts and so they could evaluate which messages were effective and didn't stigmatize workers already addicted or in recovery.
One of the radio spots begins with the sound of a jackhammer and warning beep of a backhoe. "If someone's using on the job, try to get them help. You don't want them to lose their job. You want them to keep it," a construction worker with a Boston accent says.
Listen the announcements by clicking on the audio players below.
"Tough Job"
"Second Job"
The public service announcements, which played for five weeks in July and August of this year cost $10,000 to run and reached more than 850,000 people.
At the same time, the group worked on enhancing pro-recovery awareness with carpenter's pencils and hard hat stickers carrying a message of support, and printed cards that showed a pair of construction boots and listed places to find local detox and recovery assistance.
As a longer-term intervention, the group wants to borrow from "peer support" models used in other industries, which could build on the bonds and "brotherhood" construction workers noted as a strength in the survey.
The peer support model idea was suggested in an opioid collaborative meeting the Mystic Valley group had that included partners, like the local sheriff's office, which has used that model to support health and wellness and reduce stress among its employees.
Trades workers who participated in focus groups said they'd be more likely to turn to a co-worker than to their Employee Assistance Program (EAP) if they needed help.
At first, Dustin said they hoped to build a pilot program with a local pipefitters unit that had lost four or five members to overdose death in a short period of time, and who had participated in the meetings. It faltered, in part, because there wasn't a a tangible program to put in place.
"We haven't given up yet," she said.
Dustin said a consultant from the state health department is now helping to design a model that can be piloted with a trade union or worker group that might be interested.
Meanwhile, Dustin and her colleagues are working to create a broader opioid abuse and overdose training that could be used on construction sites, hopefully as early as next year.
Peer models implemented in other industries have shown promise, Tess Benham, senior program manager for the National Safety Council said.
The century-old nonprofit has analyzed the prevalence of substance misuse in different industries, the contributing factors, the costs to employers and what's been put in place to help.
Flight attendants for example, have a successful program to address substance use, she said.
Their jobs have unique injury risks, long hours, and isolation when staying in cities away from family and friends. Often, they are hesitant to go to their employers fearing they will be labeled not "flight able," Benham said.
Their union helped create an outreach program in 2010, funded in part with their dues and money from the Federal Aviation Administration, to help screen for abuse problems, and find the right level of treatment and support.
Construction, which has a heavy union base, could implement that through its unions, Benham said.
Programs tailored to pilots or physicians also have been deemed successful, although those programs rely more on agreements that require close monitoring, strict drug testing and compliance to keep medical or pilot's licenses.
Addressing the problem early on
In Barnstable County, Massachusetts, which includes Cape Cod, health workers also started recently to look at how jobs might play into opioid overdose deaths. After looking at deaths from 2010 to 2014, they noticed deaths were high among what they called the "straight-to-work" population, those who have gone straight from high school into the workforce and often find jobs in the trade or service industries. Often those were trade and service workers.
In The Plain Dealer's data analysis, which looked at opioid overdose deaths between 2010 and 2016, people in Ohio who did not have college degrees or went from high school into the workforce also were more likely to die of opioid overdoses. About 10 percent of people who died of opioid overdose deaths in Ohio had college degrees.
Barnstable County's report, released in October, recommended bolstering substance abuse prevention efforts for vocational school students that prepare students for jobs in the trades and for those in apprenticeship programs, where students are learning their skilled trade.
That recommendation was in addition to other harm-reduction methods, such as increasing the availability of naloxone, which reverses overdoses, and treatment services in the wider community.
On Cape Cod, workers found evidence of unique challenges that might feed into opioid deaths, like isolation and lack of work opportunities in the winter and non-tourism seasons.
While each Massachusetts group has plans in place and recommendations in hand, what they are trying is just getting underway or was implemented too recently to measure effectiveness on preventing opioid-related deaths.
Dustin said the group she works with is "very proud" of what they've done, especially since it appears they are the first in the country to take aim at the problem this way.
But, she acknowledged, "there's still a lot to do."
If you or someone you know in Cuyahoga County is struggling with an addiction to heroin or other opioids, call the ADAMHS Board's 24-hour suicide prevention, mental health & addiction crisis information and referral line for adults and children at 216-623-6888. You can also access a crisis chat service online at www.adamhscc.org or text "4HELP" to 741741.