'The Ignorance Is Still Out There': Is Construction Fighting Hard Enough Against Opioid Addiction?

No industry has been hit harder by the opioid epidemic than construction, and even after years of data and investigations exposing how rampant drug use is on the job site, experts say construction companies still aren’t doing enough to save the lives of their workers suffering from addiction.

Until the coronavirus halted what had been the longest period of economic expansion in U.S. history, many cities across the country were in building booms, nudging skylines to new heights, funneling new companies into urban cores and pressuring contractors to keep projects on time.

Even as shelter-in-place orders took hold across the country to halt the spread of the pandemic, most governments deemed construction essential, and work has continued. The unwavering, strenuous nature of construction translates to a high rate of workplace injury.

“Manual labor is a struggle,” Boston-based Newton-Wellesley Hospital Director of Substance Use Services Dr. Antje Barreveld said. “Their livelihood is tied to their ability to perform. Unless their work is diversified, it’s inevitable they are going to encounter chronic pain and repetitive injury. 

“Opioids can play a role in getting them back to work.”

Construction workers account for the highest percentage of opioid-related deaths in states like Massachusetts and West Virginia. While opioid-related overdose deaths peaked in 2017 with 47,600 nationwide, they are still at epidemic levels, with 46,802 more fatalities in 2018, according to the Centers for Disease Control and Prevention. National opioid data for 2019 is still unavailable, but experts believe the crisis is still at critical levels.

While recent or nationwide industry-level data is hard to come by, construction workers have for years made up an outsized proportion of opioid deaths: In Massachusetts, from 2011 to 2015, 25% of all workers who died of opioid-related deaths were in construction. A Boston construction worker over that time frame was six times more likely to die from an opioid overdose than the average adult.

Unions have tried to prevent unnecessary deaths by advocating for contract language that promotes therapies related to opioid addiction and finding workers the help they need. Some construction management teams have held “stand-down days” to educate their workforce on the dangers of addiction.

Treatment advocates say change needs to come in areas beyond labor contracts. Some union leaders want to upend the pervasive culture of secrecy, because they say the cover-up is just as deadly as the illicit drug use.

“The culture has to change where someone can realize they’re not being a rat, but that they might save that guy’s life,” said Brendan Loftus, the member assistance educational program director at the New York City chapter of the International Union of Elevator Constructors. 

A recovering alcoholic, Loftus was spending his days on construction sites and his nights reaching out to fellow union members battling addiction and getting them into treatment programs. But preventable deaths mounted. 

Three years ago, five of Loftus’ IUEC colleagues, all men in their 20s, died of opioid overdoses within an 11-month span. He said it was a wake-up call that helping other union members after-hours wasn’t enough. He took it as a sign that he had to break through not only to those struggling with addiction, but also to members afraid of intervening for a troubled friend. 

“By ‘protecting’ them by not saying something, you’re actually killing them,” Loftus said. “At every wake I went to, two or three people came up to me and said they knew something or tried to confront them clandestinely.”

After the fifth funeral, Loftus and his union president, Lenny Legotte, sat in the back of the funeral parlor for nearly three hours mapping out a plan to try to fight the industry’s growing cycle of addiction. They decided Loftus should leave construction to go full time as the union’s workplace safety coordinator. 

“If there had been five deaths in 11 months from our local union due to elevator accidents, people would have been picketing in the streets,” Loftus said. “But people weren’t, because people don’t like to talk about it. It’s a dirty little secret.”

When Bisnow first reported in 2017 on the opioid epidemic’s grip on construction, the industry was largely silent. Three years later, it still isn’t making significant progress. 

Bisnow contacted the 50 largest construction firms in the U.S. Only six — Skanska USA, Shawmut Construction, Gray Construction, Gilbane Construction, BOND Construction and PCL Construction — spoke on the record or provided a comment after being pressed.

“Everyone is trying to wrap their heads around the problem and figuring out how we can change it,” Skanska USA Executive Vice President Bryan Northrop said. “Personally, until we speak more about this and talk about the details, it doesn’t resonate.”

The other 44 largest firms in the country, like Bechtel, Fluor Corp. and AECOM, with billions in revenue and tens of thousands of workers, either declined to comment on this story or did not respond to repeated requests for an interview. 

“You hate to say it, but most employees don’t stay with their jobs for life,” Loftus said. “For some, you’re just a number and come and go and are replaceable.”

Barreveld, a substance abuse specialist, said the construction industry still has plenty of work ahead. Ideal non-opioid treatment plans, like physical therapy and diversifying one’s workload, are hard to implement in construction where most laborers specialize in one often-repetitive skill. 

“It’s absolutely out of control, but there is no reason why we can’t do something about it,” she said. “But it takes a lot of people.”

Boston-based Shawmut Construction Chief Safety Officer Shaun Carvalho told Bisnow the company added opioid abuse training to its annual safety day in 2018. The programs have been the most popular and heavily attended of all the company’s safety programming, he said.

Shawmut leaders invited Michael Botticelli, executive director of the Boston Medical Center Grayken Center of Addiction, to keynote the 2018 event. Formerly the National Drug Control Policy director under President Barack Obama, Botticelli spends much of his current professional time on finding solutions to substance abuse in construction.

“I do think, at least here in Massachusetts, a number of companies as well as the Association of General Contractors saw the data and said, ‘We’ve got to do something here and can’t bury our head in the sand and say we don’t have some level of responsibility here to deal with the issue,’” Botticelli said. 

Botticelli told Bisnow Shawmut contacted him because there had been many instances of opioid abuse and overdoses with workers at its job sites.

“They are a national construction company and had a number of overdoses on their work sites,” Botticelli said. “Their lead safety person reached out and said, ‘We have to do something here.’”

Botticelli and Carvalho were both interviewed twice for this story. Carvalho denied twice that bringing Botticelli in had anything to do with overdoses on Shawmut’s sites. Bisnow was unable to independently verify evidence of the overdoses.

“There are no documented cases of any issue related to opioids on our sites,” Carvalho said. “I just don’t know of one … I can’t say it has or hasn’t happened.”

Following this story's publication, Botticelli emailed Bisnow to confirm that he had made these claims to a reporter, but said in hindsight he "misremembered what motivated Shaun to reach out."

"Honestly, it [has] been a number of years since I first talked to Shaun and apparently my memory is not as good as it used to be," Botticelli wrote in an email. "Shaun and Shawmut have been leaders in the construction industry and among employers in general in response to the epidemic and I would not want to mischaracterize their motivation."

Shawmut’s safety days may have raised awareness of the opioid crisis on its sites, but safety and substance abuse experts repeatedly told Bisnow that raising awareness isn’t enough.

“Our industry needs to stop putting major issues in silos and ignoring them,” said John Gaal, a retired director of training and workforce development for the Carpenters’ District Council of Greater St. Louis. “We’d push for more assistance on opioids and got pushback from construction management team lawyers who said they’re not going to do that. You know, you can now no longer claim plausible deniability, because you sat through our workshops.”

‘You’re 15 Times More Likely To Die In Construction From Opioids Than All Other Hazards Combined’

Workers in the construction industry test positive for methamphetamines and opioids 33% more than the national average, according to research conducted over the last five years by Quest Diagnostics.

In West Virginia, 32% of male opioid overdoses come from the construction industry, according to the state Bureau of Public Health. Construction workers in Ohio were seven times more likely to die from an opioid overdose than those in any other industry between 2010 and 2017.

Gilbane Building Co. Vice President and Massachusetts Operations Manager Michael O’Brien heard stories from other management groups for several years of an uptick in needles found around construction sites and behind trash containers and toilets. But it wasn’t until Massachusetts released industry-specific data on opioid abuse in 2018 that he felt the problem’s overall grip on the industry, he said.  

“When I saw that statistic, I thought, ‘Holy shit. This is a serious problem,’” O’Brien said. “It was a shock to see that many overdoses, and [it] led our industry to want to change.” 

There were 1,096 opioid-related construction worker fatalities in Massachusetts between 2011 and 2015, according to the report. There were 75 non-opioid-related deaths on construction job sites in the same time frame, according to the Occupational Safety and Health Administration. 

“If you do simple math, you’re 15 times more likely to die in construction from opioids than all the other hazards from a job site combined,” Skanska’s Northrop said. “That one statistic should really open everyone’s eyes, but you never see it printed anywhere.”

Skanska was one of the companies that declined to speak to Bisnow three years ago, but Northrop said the company has watched the opioid epidemic grow into a national problem and wants to take a more active role in helping its laborers. 

The Swedish construction giant had a zero-tolerance policy in the past for workers who tested positive for narcotics. But when Massachusetts health officials began to release statistics on opioid-related deaths in the construction industry in 2018, Northrop said Skanska and other contractors realized they needed to change their structure for handling addiction. 

“This report [Massachusetts] did was far more in-depth and broke it down to a level far more than anyone else had done before,” Northrop said. “As far as us speaking about it, in the beginning when people were asked, I don’t think folks fully understood the magnitude. I still don’t think we know all the solutions.”

Gilbane encourages employees to stop an unsafe situation if they think someone at a job site is under the influence of any substance, O’Brien said. Shifts begin with “stretch and flex,” a group exercise to loosen up joints through stretching but also give leaders a chance to see if anyone may or may not be in the best condition to work.

O’Brien, who is also the chairman of the Associated General Contractors of Massachusetts, helped organize Gilbane’s and other construction companies’ stand-down day in June 2019. The event halted work at 50 construction sites across the state in order for guest speakers to offer information on opioid abuse to construction workers as well as managers.

The second stand-down day was slated to run sometime in April, but in March mayors of cities like Boston, Cambridge and Somerville issued moratoriums on all construction activity in light of the coronavirus pandemic. 

“I don’t think we’ve gone far enough along, but some of these things, like overprescribing for pain, are outside our expertise,” O’Brien said. “Two years ago, there was a little scuttlebutt about addiction on job sites. Now, everybody is talking about it. That mere fact there is now awareness is a huge step in the right direction and our intention [is] to build on that.”  

Construction firms may care about their workers’ health, but they also can’t afford to lose any labor.  

A 2018 BuildZoom study focused on which U.S. states had the highest number of unfilled construction jobs. The report showed Massachusetts had the biggest construction labor shortage in the country, with 43% of construction jobs in the state remaining unfilled after being posted for 45 days. While the Massachusetts workforce grew by 8% between 2005 and 2016, the construction labor pool shrank by 7% over the same period.

At the same time, the state is in the middle of a historic development boom. There is nearly 18M SF of construction in Greater Boston’s commercial development pipeline — the highest number recorded, according to Cushman & Wakefield. The previous high was less than 13M SF, set in 1984.

Nationally, the construction industry lost 600,000 workers from the last economic downturn, according to the Associated General Contractors of America. Before the coronavirus crisis, the industry was expected to grow its labor pool by only 0.5% annually for the next 10 years. U.S. construction spending in March was $1.4 trillion, up nearly 5% since March 2019.

Unions like the IUEC are working to alter labor contract language where, if a labor assistance leader with the union can confirm to management that a worker battling addiction is getting the treatment he or she needs, there would be a job waiting for them at the end of recovery. Representatives with Skanska, Shawmut, Gilbane, Gray Construction and BOND said they each have similar policies for workers on their job sites. 

“With a declining skilled workforce, you do want to keep people healthy,” Lexington, Kentucky-based Gray Vice President of Safety and Field Operations Jim Grant said. 

Although Grant said opioid abuse isn’t rampant at Gray, if there is a problem and a worker tests positive, the person would be suspended for a month, go through an assistance program and, when complete, return to work and be subject to more frequent drug screenings.  

The firm also has a modified duty program where, if injured at work, the worker can have his or her duties modified as a pain management program in lieu of staying at home on prescription medication, Grant said. 

“I think we recognized early on that team members that end up getting injured and on medication, they’re sitting at home not being productive and you can lose track of them,” Grant said. “It is best to stay in tune and keep them included in the company as much as we possibly can.”

Shawmut, with 1,500 employees, has adjusted its onboarding and orientation process for new hires to include language regarding opioids, behavioral signs of someone under the influence and what to do for emergency response in the case of an overdose, Carvalho said. 

Its superintendents have also been trained on emergency response and the firm stocks most of its New England construction sites with Naloxone — better known as Narcan, a nasal spray that helps combat an overdose. The construction firm is working to expand the program to keep Narcan on all job sites. 

Skanska — which employs 38,000 — has similar workforce training and has stocked all its New England sites with Narcan since late 2018, shortly after Massachusetts released the workforce data on opioid-related deaths, Northrop said.

 “We have heart defibrillators on our job sites and other equipment to provide care for people until first responders get there,” Northrop said. “We really view using Narcan on someone who overdoses as no different than using a defibrillator for someone in cardiac arrest until professional help arrives.”

‘I’m A Fucking Slave To This Drug’

Jonathan Anderson began to work construction jobs in high school, around the time he started drinking socially and taking some pain pills recreationally. But after he broke his wrist while working his first union construction job at 19, he got his first OxyContin prescription. 

The pills took Anderson’s mind off the wrist pain, and he was able to quickly get back to his job installing elevators and keep up his usual performance levels. 

“It starts with little bullshit pain pills and spirals from there,” he said. “Most of the guys drink and take pain pills. That way you can work harder, longer and not feel the pain.” 

But he was soon hooked, and he continued taking the pills well after his wrist healed. 

“Literally, you’d just walk into the doctor’s office and, as long as you had cash to pay the doctors, you’d get a prescription and then go pick it up from a pharmacy,” Anderson said. “That whole part of it made it seem OK. The old guy’s in line in front of me going to get stuff for blood pressure, and I’m just the young guy next in line with ‘back pain.’”

Anderson admits he had a problem while he was getting his prescription from his doctor, but he said his biggest problems came when his doctor was arrested for an illegal drug operation.   

Unable to access OxyContin, he did what many other prescription opioid addicts have done: He turned to heroin bought off the street. While he said it started out as a cheaper alternative, Anderson said it eventually drained his bank account and became the all-consuming part of his life. 

The lowest point for Anderson, now 27, came four years ago. 

He recalls months where his bank account was in the negative, getting paid on a Thursday and immediately spending it all on heroin, leaving him with no money for food or gas. One night, Anderson wrecked his car, got arrested for driving under the influence and was eventually sent to the hospital.

Despite the damage to his body and personal life, Anderson was able to hold on to his construction job, something that was only possible because opioids enabled him to keep some level of performance. 

“I literally remember the feeling of, ‘I’m a fucking slave to this drug,’” he said. “It literally dictated every move I made. If I didn’t get it, I couldn’t show up.”

Anderson said it took four attempts at rehabilitation and encouragement from his union — including Loftus, his cousin — to survive and get where he is today: two years sober and working with Loftus to help other construction workers suffering from addiction.  

“Trying to get people help has been the new outlet, instead of, ‘This guy is a drug addict. Get rid of him,’” Anderson said. “Unions spend a lot of money training us. It’s not easy replacing people who do skilled labor.”

Returning to work after getting clean wasn’t easy. Most of his co-workers head to happy hour after work, something he had to avoid in order to maintain Loftus’ trust, as well as his employment.

“Not only has he been in recovery for two years, he’s been a model for the program,” Loftus said. “I remember when he was at his worst, and he was not that guy. Now, he’s helping guys and taking them to rehab. He’s a peer recovery coach.”

‘The Ignorance Is Still Out There’

Given the fragmentation in the construction industry, it isn’t clear who is ultimately responsible for getting construction workers like Anderson the help they need. 

The industry is a hodgepodge of building trade unions, subcontractors, contractors and construction management firms — and many don’t want to take the lead on addiction treatment.  

Gaal in St. Louis has focused on raising awareness on opioids in construction since 2016, when a report showed more than 3,400 Missourians died of an opioid overdose between 2012 and 2016. The opioid epidemic is keeping roughly 1 million people out of the Missouri workforce — and most are in construction, according to a University of Missouri-St. Louis report. 

But the data hasn’t been enough to motivate construction companies to do more, Gaal said. 

“We push for more awareness, more aid, you name it. They push back,” he added. “That just goes to show you the ignorance is still out there. When your leader of safety doesn’t believe what we’re saying, your C-suite isn’t going to believe it either. It’s one of those unfortunate occurrences where, until it hits home, it doesn’t hit their radar.”

Ideal, opioid-free pain management plans for construction workers are futile or nearly impossible to implement, Gaal said.  

Developers hold massive projects to strict timelines in light of ever-increasing construction costs, which means a worker can’t afford to take a month off to go to a physical rehabilitation program. Medical experts like Barreveld and labor leaders like Gaal both said the ideal scenario for workers would be to find a diversity in workload, but that can be hard given the nature of the industry.  

Most in the field find a trade specialty and repeatedly perform that trade until retirement, a strenuous cycle lending itself to a higher rate of workplace injury. There are alternative pain management plans, like massage therapy, but they often come at a high cost and longer recovery timeline than health insurers or project managers permit. 

“Even yoga is effective, yet very few insurance plans approve these as alternative strategies to pain,” Gaal said. “The insurance companies tell us they’ve never operated that way. That still doesn’t make it right. So, if you’re the breadwinner, you have to find another way to mask the pain.”

The Midwestern construction firms Bisnow reached out to either declined a request for an interview or, in the instance of St. Louis-based McCarthy Holdings, recommended Gaal speak regarding the opioid epidemic’s impact on construction. 

Some construction management firms defend against Gaal’s claim and say they are changing their attitude. 

Kathy Freitas has overseen workplace safety and health policies at Boston-based BOND Construction, which specializes in areas like life sciences, healthcare and infrastructure, for 40 years. Given the rise of the opioid epidemic in Massachusetts, Freitas said BOND has taken a more hands-on approach to worker safety rather than relying on unions to handle the matter, as they had done in the past.

“‘Say no to drugs’ doesn’t work. You have to take a more in-their-face approach,” she said. “An organization can’t wait until a problem is on their doorstep. They have to get in front of it and find people the help and resources they need.”

Freitas said BOND, which has been around since 1907 and employs nearly 800, originally had a three-strike policy for construction workers on a job site who tested positive for an illicit substance. That evolved into a zero-tolerance policy during the “Just Say No” era of the 1980s and 1990s, when cocaine abuse was spreading through work sites. 

“It should probably be somewhere in the middle. Having done this for 40 years, every case is different,” Freitas said. “You have to say to someone, ‘We want to work with you, we’ll hold your job, work with you, get you help.’”

Across the country, construction unions have made the fight against opioid abuse a central part of their operations.  

The North American Building Trades Union, a group of 14 national and international construction unions, set up a task force in early 2018 to address the opioid crisis and prevent further deaths in construction. 

The Chicago Regional Council of Carpenters and Rock Island, Illinois-based International Union of Operating Engineers Local 150 filed a joint lawsuit in February 2019 against a variety of opioid manufacturers, distributors and prescribers like Purdue Pharma, a Johnson & Johnson subsidiary and the American Academy of Pain Medicine. The lawsuit seeks financial relief for money spent helping members who have been impacted by the opioid epidemic. 

“Workers experiencing pain-related injuries have been overprescribed opioids that have little if any medical benefit and lead to addiction, despair and death, while our welfare funds have been compelled to shoulder the unjustifiable financial burden of related health care and disability payments,” IUOE Local 150 President and Business Manager James Sweeney said in a statement when the lawsuit was filed.

Representatives with both Illinois unions didn’t respond to a request for an interview.

Even in retirement, Gaal continues to work across Missouri and other parts of the Midwest to encourage construction companies to conduct opioid safety training, promote alternative pain management and address workers’ mental health. 

Members of the carpenter’s union have to attend eight hours of safety training each year to remain in good standing. Gaal said he wants more management firms to buy into a similar training in light of how vulnerable construction workers are to prescription misuse. 

“Say you start out in this industry as a 23-year-old and hang drywall for 40 hours of the week — God didn’t make your body to sustain that kind of punishment,” Gaal said. “If you’re the breadwinner, you have to find a way to mask the pain. Some drink. Some take pills, and a lot of the doctors stopped cold turkey on those people. You can’t do that.”

Addiction in all forms still has a stigma attached to it, and it can lead to problems being swept under the rug. Many companies are still afraid to talk about the epidemic because of optics, Freitas said. 

“One of the reasons people are reluctant to talk about it is, if BOND talks about it, there’s this school of thought of ‘Oh, all the BOND people are messed up,’” she added. “No, our people are no more messed up than anybody else.” 

Stand-down events are gaining in popularity. Increasingly, those measures include the importance of confronting an employee who might be under the influence.

“The funny thing is, when you do a stand-down day and talk afterwards, they start talking and start breaking down those barriers of ‘don’t ask, don’t tell,’ because everyone can tell a story about someone they worked with,” Freitas said. 

Anderson said open conversation is a first step in the right direction for his industry. Life today is a lot different than when he started out in the business. Instead of immediately spending his paycheck on pain pills or heroin, Anderson now attends group addiction recovery meetings every Monday and Wednesday night. 

“I think it’s getting better in that it’s talked about,” Anderson said. “Guys know what to look out for, and instead of writing someone off, we’re just all trying to get someone the help they need.”

If you or someone you know are in the construction industry and have a story to tell about dealing with the opioid epidemic, we want to hear from you. Email ethan.rothstein@bisnow.com.

CORRECTION, MAY 26, 1:50 P.M. ET: Bisnow was unable to independently verify whether overdoses occurred on Shawmut job sites. This disclaimer has been added to the story.

UPDATE, MAY 27, 3:30 P.M. ET: This story has been updated with a new statement from Botticelli.