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>> We first started to notice a serious issue
with opioids amongst our membership probably going back
into 2010-2011.
We were operating a national drug testing program
in conjunction with our contractors and our clients.
And we started to see our positive drug tests,
where traditionally you'd think marijuana
or cocaine use would be the preponderance of them but all
of a sudden we started to see --
we had more people testing positive for opioid use
than we did for the other drugs.
At the time, we didn't have a lot to make of it.
We didn't really understand what was going on.
>> The first opiate was from a poppy plant
and produced what was called opium.
And from opium, many new products were made, morphine
and things used in medicine.
Those were called opiates
that were derived from the poppy plant.
From 3,000 years ago, we knew they helped pain
but even 3,000 years ago they also knew
that people would feel good on them and that was a problem.
>> Several years ago, we embarked on a study to look
at opioid-related overdose deaths
by industry and occupation.
We have community partners around the state.
And several of them were looking at their death certificates,
and they were saying, "We're seeing lots of workers
in the trades, mostly construction workers
but other blue-collar trades."
So we said in occupation health,
"We look at the death certificates all the time
by industry and occupation so we can look at this for you.
Let's look at it statewide."
So we undertook this study to look
at opioid-related overdose deaths
by industry and occupation.
We decided to go beyond just counting the deaths
and the rates but also begin
to explore what could potentially be some
of the contributing factors that might account
for these differences.
>> So when we saw this high rate
of opioid-related overdose deaths,
one of the first things we thought about was --
well, what are construction workers --
what do they experience at work that's different
or worse than other workers?
And the first thing our minds went to were,
the occupational health surveillance program,
is occupational injuries.
So construction workers have much higher rates
of occupational injuries at work but also fatal injuries
at work compared to other workers.
We also know that construction is a precarious industry
in a lot of ways.
Workers don't always have a guarantee of work,
especially if they're non-union.
So we thought that precarity might contribute to the need
to work in pain, for instance.
Working in pain might contribute to using opioids in order
to not be in pain while you're working and then also might lead
to misuse down the road.
>> It's a hard business that we work in.
It's injury.
There is no time off.
There is no sick time.
There's no paid vacation, so to speak and, you know,
they work with their injuries.
>> I think construction industry
as a whole has a much higher risk because of the work we do,
the wear-and-tear on the body, the physical pain that most
of our members go through and not knowing how to deal with it.
>> Before becoming a union iron worker, I worked as a laborer.
What got me into the drugs were
from doing all this manual labor.
I would get hurt or go through pain, put in a hard day's work,
and I needed something stronger,
something to numb not only my physical pain
but the one mentally that was going on up here.
I hit a very low bottom due to these drugs,
and I was just stuck in this vicious cycle with no solution.
>> Our jurisdiction is New York City and Long Island.
I started following overdose rates in Long Island around 2006
and watched it jump from 40 a year to 68 to 120.
>> There is one study that was done in Massachusetts
of commercial construction workers
where 70% reported working in pain and in that same study,
they reported high prevalence of mental health issues.
And one of the hypotheses that those authors had was
that construction workers don't necessarily seek the help they
need when they confront psychiatric problems or stress.
>> I think construction workers don't seek help
as often as they should.
And I think this is true for any industry.
It's fear.
We are all full of fear, and we all fear what other people think
of us or we fear success.
We fear change.
We fear failure, but I think fear drives a lot
of people to not seek help.
And in particular in construction, I think,
that you're around a bunch of manly men, tough guys, you know,
and you're building cities.
You know, to come forward and say, "Hey, I'm struggling
with such and such, a drug or an opiate or alcohol."
You always think the person next to you is going to think less
of you and, you know, you're not going to fit in.
>> The question of how we approach addictions today
has shifted.
You will hear people say it's a medical illness
and so that's called the medical model.
That's what we call --
it's purely physiologic meaning it has to do
with how the body is working and reacting.
In psychiatry, we go a step further and we look
at what's called the biopsychosocial dimension
of an addiction.
What that means is bio would be genetic, psychosocial has to do
with -- psycho is your temperament.
Some people have hot or cold temperaments, if you will.
And then the last one, which is probably the most important part
for everybody to know about, is the social setting.
Did you grow up in an abused child relationship?
Did you grow up in a neighborhood
where drugs were prevalent?
And, of course, for construction workers,
the tough thing is high demand, high stress,
a lot of bodily injuries, and the availability of opioids
as so that's the social setting.
>> The nature of the business is we get banged up.
We're in pain.
There's a lot of drugs on the jobs.
A lot of guys are using.
It's easily accessible.
A lot of the guys have the mentality,
we work hard, we should play hard.
And the overdoses started becoming more rampant
with the fentanyl because the heroin has kind of disappeared
and that's primarily the drug of choice now.
>> Somebody working under the influence of opioids
in the construction business not only puts their life at risk
but puts the lives of their co-workers at risk
and potentially the public as well.
>> There is not a day that goes by, you don't turn the news on
or open the newspaper and it's right there.
So it's every single day.
We see it.
We're trying on the defensive end and trying
to just figure it out.
How to handle -- get that person, get them healthy,
and get them back to work and being safe.
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