Be advised, we are all miles inside an active battle zone. It’s comprised of officials with the American Medical Association; worldwide pharmaceutical giants; corporate CEOs; government bureaucrats at the local, state and federal level; law enforcement; hospitals and first responders; and friends and coworkers on every jobsite. Recent medical studies of rampant opioid prescriptions put our society as far as twenty years into this conflict. As we’ve heard so many times in military applications, “It doesn’t matter how we got here. It’s how we get out that matters now.” Sales of prescription opioids to pharmacies, hospitals and physician’s offices quadrupled from 2000 to 2010, grossing more than $11 billion in 2012 and resulting in 64,000 fatal overdoses by 2016. It won’t be easy to get out this time.
Just What is an Opioid?
Opioid pain relievers such as Oxycodone®, Oxycontin®, Hydrocodone®, Fentanyl® fall under the broader category of opiates (including morphine, codeine and heroin). Today’s opioids are a recent class of man-made “opiate-like” pharmaceutical compounds that bond with one or more of the body’s three types of opioid receptors (much like morphine) in order to block pain signals between the body’s sensory nerves at the injury site and the trauma victim’s opioid receptors in the brain. These receptors are also affected by the body’s natural production of five endogenous opioids, the most well-known being endorphins. Today there are nearly a dozen common brand names for synthetic opioids available in the pharmaceutical marketplace, with more likely to be developed to meet future demand. The opioid receptors located throughout our body in the cerebral cortex, the spinal cord and digestive system not only control pain reception, mood, decisions making, and the digestive process, but also have side effects. That includes suppressing the functions of our autonomic nervous system, reducing levels of consciousness, causing convulsions, slowing breathing and in the case of an overdose, stopping completely, causing death.
How Do They Differ?
With the advent of Squibb’s non-fragile Syrette injection system, morphine sulfate was a widely-distributed pain killer used by field medics and soldiers during World War II and the Korean and Vietnam wars. Much like a miniature toothpaste tube with a sterile needle, it was durable, easy to administer and the used Syrette was pinned to the soldier’s collar to indicate he had been previously dosed. Unfortunately as a result, many returning veterans brought their battle-zone opiate addiction home with them. Today, there are a significantly greater number of veterans surviving severe battle trauma due to advanced battlefield triage procedures and medical advances. That includes synthesized opioids given for pain management.
Medical experts consider most synthesized opioids to be one-and-a-half to two times more powerful at stopping pain perception than morphine. An Oxycodone prescription of 30 mg could require an equivalent morphine dosage ranging anywhere from 45 to 90 mg. Opioids were first thought to be less addictive alternatives to morphine, but all opioids are still extremely addictive. Although the precise psycho-biology of addictive behavior is still relatively unknown, equal dosages of Fentanyl® prove to be anywhere from 50 to 100 times the strength of morphine or heroin, and some believe 10 to 20 times more addictive to most users.
The process of addiction is different in each body, relative to the production of dopamine the body creates inducing an intense euphoria and ultimately pain relief. It’s been proven that the dopamine production caused by Oxycodone®, Hydrocodone® and especially Fentanyl®, is much greater in concentration and duration of effects than either morphine or heroin. According to the U.S. Center for Disease Control (CDC), drug overdoses became the leading cause of injury deaths nationwide in 2014, with synthetic opioids causing an astounding 70 percent of those deaths. The CDC claims 2017’s fatality rate due to opioid overdose now averages about 174 deaths daily, or seven per hour. Both legal prescriptions and illicit sales of opioids have risen exponentially in the past 10 years. According to a Jan. 4, 2018 New York Times investigative article, a flood of Chinese Internet sales of Fentanyl in the U.S. totaled more than $800 million last year alone. Whereas, the U.S. is only about 5 percent of the world’s population, we consume approximately 80 percent of the world’s opioid supply. Unfortunately, wherever regional availability and costs affect supply and demand for prescription grade opioids in illicit markets, lower cost (but often tainted) street level heroin sales increase proportionally among opioid addicts, thus compounding the number of fatal overdoses.
Drugs in Construction
A 2017 study of opioid use among the building and construction trades was conducted by CNA, one of the country’s largest insurers of construction firms. It revealed that construction workers were among the most susceptible to opioid abuse, second only to those in food service.
CNA estimated over 15 percent of all construction workers “have engaged in illicit drug use,” with most having started with opioid prescriptions after a job-related injury. Men are twice as likely to abuse prescription drugs than females, according to Eric Goplerud with the Department of Substance Abuse Mental Health and Criminal Justice Studies at the University of Chicago. According to the National Institute on Drug Abuse, adults age 18 to 25 are the sector more likely to abuse opioids.
Work-related injuries have led to an explosive increase in doctor-prescribed pain relief in the past 10 years. Common explanations for this industry-wide addiction include:
A rapidly aging workforce with the diseases and disorders that come with age, and a slow influx of young recruits.
Socio-economic pressure to perform at a higher level to keep a job despite chronic pain.
This necessity to keep one’s job despite the harsh conditions and strenuous activities on a construction site puts the builder, co-workers, and sometimes the general public at a greater risk of injury due to accidents. Any drug use meant to alleviate the employee’s pain typically increases the employer’s general liability as well as workers’ compensation insurance rates. This may lead to a corporate denial of widespread opioid use among employees and a reluctance of management to take the steps necessary to effect a change in the outcome. While the skilled construction labor force in this country is in decline due to this epidemic, the end result is a preventable and yet ever-rising loss of lives.
What To Do? When?
As today’s headlines testify, the focus has shifted from public education to preventing deaths from overdoses via first responders. The use of the reversal agent Norloxone (Narcan® or Evzio®) applied with nasal syringes by emergency responders is becoming a widespread life-saving practice.
In addition, many state-sanctioned, publically managed methadone clinics offer addicts a long-term and regular maintenance program with buprenorphine (Suboxone®), which activates the opioid receptors just enough to prevent serious withdrawal symptoms in the addict and reduces psychological cravings, without enough receptor stimulation to produce euphoric symptoms or cause an overdose. It’s a controversial belief held by some in the recovery field that while addicts may recover, they remain addicts for life. A detox recovery program, along with drug counseling, 12-step programs and lifestyle changes may help to prevent another relapse. This allows both the brain and body the opportunity to heal. Personal-use triggers should be avoided during early recovery and, in time, addictive behaviors may be psychologically modified into healthier responses. Experts suggest that recovering drug addicts can continue to experience a resurgence of their disease even when not using, in other obsessive aspects of their lives, such as alcohol, sex, food, work and even exercise.
Many public health officials suggest a wide-open discussion of this national health crisis, including the ranking all pain-relieving drugs, from Ibuprofen to medical marijuana, Prozac to Fentanyl, according to an individual worker’s risks assessments. In conjunction with mandated drug rehabilitation programs, union and non-union officials are just beginning to consider low-risk job reassignment and “protected” leave policies for those who depend on stronger pain relief products during working hours, whether or not they have become physically addicted.
Today, the legal ramifications of construction contract indemnification vary greatly from state to state. Under certain conditions, a construction accident involving an employee who tested positive for drugs or alcohol may not only initiate a legal action against his direct employer but also the prime (or general) contractor as well as the property owner. Unfortunately, the potential for litigation has the terminal effect of sealing most lips, precisely when an open and brave discussion is a national necessity. In some states union project labor agreements and contracts contain protective language where an employer who reasonably suspects a worker of drug or alcohol use on the job may either remove them off-site or restrict their access altogether without penalty prior to a formal investigation.
On Jan. 10, Pennsylvania Gov. Tom Wolf became the nation’s first governor to sign a statewide disaster declaration to combat the serious heroin and opioid epidemic in his state. It established a Pennsylvania Emergency Management Agency Center to counteract the onslaught of what’s perceived as a national economic and health crisis of enormous proportions. Its mission will be to immediately save lives, get addicts into meaningful treatment and improve statewide disaster communication, command and control.
In support of the initiative to waive statutory regulations that create barriers to addiction treatment and prevention, Wolf invoked his executive authority to develop 13 initiatives in three areas of focus:
- Enhancing coordination and data collection;
- Improving tools for families and first responders to save lives;
- Speed up, and expand access to drug treatment.
The alarm has been clearly rung. The clarity of Wolf’s executive action to of shred government red tape at this time should resound with all citizens of our union, no matter what state we live in. As concerned human beings, as well as employers of a vulnerable construction workforce, we should all send a copy of his declaration to our own elected officials, encouraging them to take similar stands immediately. We should also consider all of our employees vulnerable to this epidemic disease and do all within our power to destigmatize drug addiction as a moral degradation, rather than a disease potentially afflicting anyone and capable of destroying our country in a generation or less.