Opioids and Fit for Duty

Recently, the OGCA participated in a fulsome discussion with the Toronto Officer of Health; the Ministry of Labour Training and Skills Development (MLTSD); the Ministry of Health; the City of Toronto and Toronto Public Health; construction industry stakeholders from all sectors; organized labour; substance abuse and addiction experts; and doctors, on the growing concern over opioids in construction.

The impetus for this discussion was the campaign launched on May 31, 2021 by the Ontario Construction Consortium (OCC) titled “The Other Pandemic – Opioid Crisis in Ontario.” The hope was that this campaign would raise awareness of the opioid drug overdose crisis that is affecting the construction industry. As drug overdose deaths have continued to climb dramatically in Ontario, the construction industry workforce is being impacted more than any other sector of the economy.

Toronto Public Health provided details that of all the opioid cases, ten percent (10%) were employed. When that figure was further analyzed, it was determined that the employment breakdown consisted of a further 33% categorized as construction. Therefore, the roundtable discussion was to provide viable solutions to how construction could effectively prevent these opioid deaths from occurring. Clearly opioid use is not the sole realm of construction, since people from all demographic and socioeconomic groups use substances. The OCC campaign simply raised a concern amongst those in construction that prompted the discussion into what could possibly be done to address this challenge.

The focus on construction is due to its very physical nature and hence the industry has a much higher propensity of injury, when compared to other sectors of employment. The injuries in question that are occurring in construction are not those of a critical nature, but instead cause the recipient constant or recurring pain.

The issue is in the management of that pain. Medical professionals have, in the past, had a higher propensity to prescribe opioids as a means to mitigate or alleviate that pain.

But if they are bad for you, why do physicians continue to prescribe those opioid drugs to people in pain? The quick answer is because opioid drugs are perfectly aligned to alleviate pain.

The Mayo Clinic notes that “people naturally have ‘opioid receptors’ in our brain and these are involved in [naturally] monitoring our stress responses, mood, learning, memory, and more. As humans, we’ve created opioids that closely resemble the ‘code’ that our natural opioid receptors have, so they work similarly in blocking pain. The problem is that since they’re substances, they do create addictive effects.”

Opioids create physical dependency since the substance used will actually bind to and activate opioid receptors on cells that are located in the brain. Harvard University emphasizes that “when opioids lock onto a cell, they affect the way we think, feel and control our bodies.” The messages communicated between our cells become altered, which also alters how the signals of pain are registered. Pain is no longer registered at the same level and is often “muted” when opioids are taken.

Understand that this discussion was not an admonishment of construction or some admission of guilt, but instead, a means to address a growing concern within construction about this issue. On a positive note, construction, unlike most industries, has a higher tier of health and safety policies and procedures enacted to address many issues and hazards facing workers. Similarly, the construction industry has formulated Fit for Duty requirements that are not only best practices throughout the sectors, but are constantly being updated. This places construction in a unique position to better comment on and address this challenge towards, hopefully, the elimination of preventable deaths from opioid poisoning or overdose.

A further compounding effect on substance use and abuse was how people dealt with or coped with the stresses brought on due to COVID-19. The pandemic has caused a reduction in access to services and social supports for people; social isolation that could lead to consuming drugs alone; and for some, an overall feeling of hopelessness. These have been contributing factors in opioid related deaths and cannot be overlooked since 2020 saw a 60% increase in opioid related deaths in Toronto over the previous year.

So, what does the OCC note as possible remedies in their campaign? Their key campaign messages are as follows:

  1. Do not use hard drugs alone.  Use in the company of another individual with a Naloxone kit close at hand or go to a supervised injection site.
  2. As this advice will bring the worker into close company with other people, OCC urges all construction workers to get vaccinated against COVID-19.
  3. Unions and contractors must step up training and education regarding drug use and its possible consequences.
  4. Governments need to increase addiction treatment and counselling services to meet this unprecedented challenge.
  5. Workers wrestling with addiction should seek help.   With a public health crisis manifesting itself in a 60% increase in deaths in one year, there was never a better time to stop using hard drugs if at all possible.

For further information on this campaign please visit: The Other Pandemic – Opioid Crisis in Ontario.

Should anyone want to discuss the opioid roundtable discussion with Toronto Public Health and construction stakeholders, or if you require any assistance from the OGCA, please contact me directly at giovanni@ogca.ca or via phone at 905.671.3969.