Construction workers operate equipment at a work site in Manhattan. (Credit: Anna Lee)
Legislative action around the opioid crisis often overlooks the specific harms that construction workers experience. That’s changing.
In the latest effort to address the opioid crisis on a citywide scale, New York City Council Member Linda Lee proposed Intro. 1385 on Sept. 10 — a controversial bill that would require the commissioner of Health and Mental Hygiene to institute an opioid antagonist program for the immediate treatment and recovery of workers who have overdosed on the job.
The program would provide overdose prevention training to site safety professionals at each major building construction site, along with five on-site kits stocked with opioid antagonist medications, like naloxone. “This initiative will ensure that construction sites are equipped with opioid antagonist kits to reverse the effects of deadly overdoses and connect individuals to recovery and support,” Lee said in a statement to Columbia News Service.
The National Safety Council flagged construction workers as having the most unintentional workplace overdose deaths of any occupation — a number that has steadily risen over the past decade. There were a record 98 fatalities in 2023, compared to nine deaths in 2013.
Construction workers are often prescribed opioids for pain management, which can be caused by musculoskeletal disorders incurred from work site injuries and overexertion. According to a new report from the Center for Construction Research and Training (CPWR), opioids are even prescribed for minor injuries that don’t require them, causing concern for the industry’s already high overdose rates.
“There are many paths to dependency on opioids, and the really crystal-clear path from our research is pain,” said Chris Trahan Cain, an executive director at CPWR. “The development of pain from an injury or from a repetitive use situation — back pain, knee pain — all of these things caused by work, caused by conditions that the human body is subject to that can be changed.”
Bill Cuff, a laborer with around nine years of experience in construction, and a shop steward of the Laborers Local 1010 union, told Columbia News Service that he carries Narcan in the center console of his vehicle.
“We have guys who are suffering and struggling at the company I work at, and the union as well,” Cuff said. He said he regularly helps other construction workers dealing with substance and opioid use, who often call him for assistance.
In the city’s efforts to mitigate this opioid crisis among construction workers, experts and advocates have not reached a consensus. During the latest hearing on Intro. 1385 on Sept. 26, the Committee of Mental Health, Disabilities, and Addiction listened to a range of opinions from construction safety advocates.
Organizations such as the Building Trades Employers’ Association (BTEA), which is the largest contractor association in New York, offered memorandums of support. Conversely, two groups submitted respective memorandums of opposition: the Empire State Chapter of the Associated Builders and Contractors (ABC), and the New York Construction Safety Alliance (NYCSA) — a coalition of New York City-based construction site safety companies.
One supporter of the bill is Mohammed Saleheen, a development director at the Building Trades Employers’ Association. Saleheen described Intro. 1385 as “a small investment [that] might end up saving a life.” While the bill would only mandate the institution of opioid antagonist kits at job sites, Saleheen stated that the program could “have ripple effects for people who are having a problem far away from a construction site.” According to Saleheen, the program would help attract awareness to opioid use issues and the trainings it would provide could be instrumental resources for workers both on and off the job site.
For others, the bill could be more ambitious. The opioid antagonist program would only be instituted at construction sites for major buildings, which the city’s Department of Buildings quantifies as buildings that are at least seven stories or 75 feet tall. To Cain, the program’s distribution of opioid antagonist kits should be provided to construction sites of all sizes, not just those that meet the height threshold.
“Until we solve the problem of fatal overdoses in the population in the country, we need them everywhere,” Cain said.
The opioid antagonist program aims to decrease the time between an overdose and the administration of naloxone by keeping kits on construction sites. Currently, emergency medical services are usually the first called to the scene on construction site accidents, including overdoses. Under the protocols established by the New York State Department of Health, emergency workers are tasked with identifying and administering naloxone to people who they suspect have overdosed. They may also provide naloxone kits to people who have overdosed or leave kits in the care of the friends and family of those people.
Through Intro. 1385, Lee wrote in her statement, “our cxity is affirming its commitment to safeguarding not just physical well-being, but also the mental health of the construction workforce.”
Some construction safety advocates are concerned that the bill will primarily impact the responsibilities of site safety professionals, who would take on additional duties under the opioid antagonist program. In both memorandums of opposition, the Associated Builders and Contractors and the New York Construction Safety Alliance stated that the opioid antagonist program could burden site safety professionals with medical responsibility, distracting them from attending to other work site accidents or deaths.
Site safety professionals ensure that construction sites comply with the safety standards outlined by the Occupational Safety and Health Administration and city building code. The proposed bill would expand the responsibilities of site safety professionals to include the administration, maintenance, and submission of reports about the provided opioid antagonist kits.
ABC raised concerns about these responsibilities in its memorandum, expressing that medical responsibilities could confuse and overwhelm site safety professionals, exposing them to greater liability risks from individuals or families who could allege that naloxone was administered incorrectly. Opioid antagonist resources, ABC argued, would be better funneled toward first responders and medical personnel who are already trained on opioid antagonist administration.
For Cuff, the responsibility should not be solely placed on site safety professionals, but expected of all workers on a construction site. “There should be more training, all around. If it saves one life — what’s the harm in having more [Narcan]?” Cuff asked.
The NYCSA memorandum concurred with the ABC’s concern for the responsibilities of site safety professionals, but suggested amendments to the language of the bill if the Council continues to pursue the opioid antagonist program. The group also recommended that the program be tested on a smaller scale before a citywide deployment. There have not yet been any mandated opioid antagonist programs at construction sites in the U.S.
According to communications strategist Diane Cahill, who works alongside ABC and NYCSA, “the bill has the right intentions.” However, Cahill added, the bill must supply data about the frequency and circumstances of overdoses across the city’s construction sites to determine whether the opioid antagonist program is the best method of intervention. Cahill said that the bill would also need to factor in input from the Department of Buildings, which defines and determines the responsibilities of site safety professionals in New York City.
Lara Maldjian, an associate director at the New York Committee for Occupational Safety, said she rarely comes across work site fatalities characterized as an overdose. In federal data analyzed by the CPWR, 109 out of nearly 16,000 fatal overdoses among construction workers took place at work in 2023.
Maldjian also raised cost concerns. In the fiscal impact statement for Intro. 1385, the five naloxone kits are estimated to cost about $200 for each major building construction site, though it cannot yet be determined how many sites would qualify for the program. Using a general fund, the program would also require an annual $1 million to hire six staff members to administer the program.
“The emphasis should be on training the workers, and giving them kits to take home,” Maldjian said. “[An] overdose can happen anytime, anywhere.”
About the author(s)
Anna Lee is a general assignments reporter based in New York and Boston. They are currently reporting on environmental legislation and criminal justice reform.