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Opioids and Pain Management in the Construction Industry

September 10, 2019
An unrelenting crisis affects those in the manual labor workforce

With Frank Manzo IV, MPP and Elmer G. Pinzon, MD, MPH, DABIPP

The opioid crisis may be devastating the construction industry more than any other, as this class of workers has a higher proportionate mortality rate from opioids—including synthetic, semisynthetic, and natural formulations—than those working in other occupations.1,2

In Massachusetts alone, construction workers accounted for 25% of all fatal opioid overdoses among job holders between 2011 and 2015.Likewise, in Ohio, in 2016, construction workers were shown to be seven times more likely to die of an opioid overdose than those in other industries.The problem is not specific to just these states, however: Between 2007 and 2012, just over 7,400 construction workers across 21 statesdied from an opioid overdose.5

Construction workers are more likely to not have health insurance, proving non-opioid alternatives to be a costly venture. (Source: 123RF)

What Accounts for the Occupation Discrepancy?

Injuries: This trend among construction workers may be explained by the frequency with which they sustain injury and subsequently obtain prescribed opioids for the pain. As just one example, 44% of all workers’ compensation claims involving prescriptions included at least one opioid.6 Opioids are also generally accessible and relatively inexpensive, making them common among pain-plagued construction workers.

As seen in a 2018 Midwest Economic Policy Institute brief (Addressing the Opioid Epidemic Among Midwest Construction Workers):7

Construction is one of the most physically demanding and dangerous occupations in the United States. The injury rate for construction workers is 70% higher than the national average for other occupations…In recent years, most workers compensation claims have involved opioid prescriptions…Opioids account for about 20% of all total spending on prescription drugs in the construction industry, which is 5 -10% higher than its share of spending in other industries.

Demographics: “For historical, structural, and cultural reasons, men are more likely to be opioid users, and construction is a male-dominated workforce,” Frank Manzo IV, MPP, co-author of the Midwest Economic Policy Institute brief, told PPM. “Some research has shown that men are more susceptible to opioids; 61% of those who misuse pain medications are male,”8 he added. The rate of substance use disorders is close to 16% among construction workers,9 significantly higher than the national average of 8.6%, according to the National Safety Council.10

Financial concerns: “In the aftermath of the recession, there was less construction work available in many sectors, so workers did everything they could to work as many jobs as possible,” Manzo explained. “Construction work is seasonal; if you’re injured towards the end of the season, you only have a few weeks to earn money for your family.” While the industry has recovered from the worst of the recession,11,12,13 for overworked and/or injured workers worried about making money, a “pop a pill and get back to work” mentality is common, he said.

Age: The median age of US construction workers is 42.14 Workers over age 40 are more likely to receive opioid prescriptions than their younger counterparts, according to the Workers Compensation Research Institute.15

Other:  According to Elmer G. Pinzon, MD, MPH, DABIPP, medical director, president, and owner of University Spine & Sports Specialists in Knoxville, Tennessee,  “Job satisfaction, preexisting psychological issues (eg, depression, anxiety, post-traumatic stress disorder), limited education, redundant or repetitive job duties, and inadequate employment skills,” might also encourage the use of opioids among this population, said Dr. Pinzon, who is also a member of the PPM editorial advisory board.

Weighing Treatment Challenges

As healthcare providers well know, there are many safe and effective alternative pain treatments that can be used prior to, or in conjunction with, opioids. Dr. Pinzon recommends physical therapy or chiropractic manipulation; non-opioid prescriptions such as NSAIDs, topical analgesics, and muscle relaxants; and durable medical equipment such as lumbar sacral orthoses, cervical braces, transcutaneous electrical nerve stimulation (TENS) units, and other devices when needed. In addition, depending on the case, interventional pain management procedures may be beneficial. These may include injections (trigger point, intraarticular joint, epidural steroid, medial branch, facet joint), radiofrequency nerve ablations, or minimally invasive surgical procedures.

Unfortunately, as Manzo pointed out, many construction workers don’t have health insurance. In fact, 11 of the 20 professions least likely to have health insurance are in the construction industry.16,17 A lack of insurance can make non-opioid therapies prohibitively expensive; a look at FAIR Health Consumer, a searchable database that estimates healthcare costs,showed that in Aurora, Illinois (one of the 10 states where 60% of US construction work is currently concentrated)18 a single doctor’s visit for trigger point injections would cost an uninsured worker an estimated $1,000.19

Additionally, since “Construction workersare also more likely to be self-employed, or independent contractors,”20 according to Manzo, they often do not qualify for workers’ compensation benefits.21

When to Phone in a Specialist

All patients presenting with pain-related conditions should undergo an extensive physical exam and submit a thorough medical history, but for construction worker patients, in particular, Dr. Pinzon recommends referral to a musculoskeletal pain specialist, such as physical medicine and rehabilitation physician (PM&R)/physiatrist or occupational medicine physicians. He also often recommends interventional pain specialists who can help to initiate early treatment after a construction-related injury. “This approach may prevent chronic disabilities and subsequent opioid drug dependence or addiction,” he added.

Last updated on: November 22, 2019
Continue Reading:
Treating the Opioid-addicted Chronic Pain Patient: The Role of Suboxone
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