Ontario’s Provincial Building Trades are calling for a new approach to construction’s opioid crisis, offering a solution being tagged as Total Worker Health.
Building Trades director of occupational services Carmine Tiano says there are many well-intentioned initiatives being developed by the likes of Ontario’s Ministry of Labour, the Chief Prevention Officer, the Infrastructure Health and Safety Association and the federal government, with plenty of attention being paid to the rampant growth in opioid deaths among construction workers. And there has been significant public health research conducted.
“Here’s the problem,” said Tiano. “You’re focusing on the opioids, you’re not looking at what the problem is. You’re not looking at the correlation — has the construction work environment led or contributed to substance use, not only opioids, in the construction sector?
“When I approached the Building Trades I said, ‘let’s take a different approach. Let’s look at musculoskeletal chronic pain and opioids as the result.’”
Tiano recruited several presenters including Building Trades Workers’ Services reps Brad Valley and Matt Ferguson for a workshop held during the recent Building Trades conference in Windsor.
Tiano teamed up with Dr. Don Castaldi, a public health consultant, to address chronic musculoskeletal pain.
During the pandemic, Tiano said, research has shown that of the nearly 2,500 opioid-related deaths reported in Ontario, 30 per cent were among people employed in the construction industry. Nationally, of people who were employed at the time of death, 30 to 50 per cent were employed in trades.
Most of the policies that have been developed to deal with opioid use disorder and opioid overdose deaths have focused on implementing guidelines that restrict opioid prescribing, Tiano noted. While the efforts have reduced opioid prescriptions, they have not been accompanied by an increase in the availability of safe alternative pain management options.
A De Novo Treatment Centre study from 2021 titled The Five Drivers of Substance Addiction/Suicide found a perfect storm of those factors in construction: work habits and schedule; personal relationships; stress, anxiety and depression; financial pressures; and discrimination and abuse.
The study’s results indicated workplace habits and schedule were the leading driver (44 to 49 per cent) of substance use and suicide among construction workers. Forty-five per cent of construction workers over 50 have chronic back pain.
Too often, Valley and Ferguson said, doctors opt for the quick and easy fix for pain — opioids — instead of more time-consuming therapies.
They cited the vicious cycle of work injury, WSIB claim, opioid prescription, persistent opioid use including a resort to illegal sources once a prescription has ended, opioid morbidity, then opioid mortality.
The presenters said the WSIB system can pose challenges for those applying for benefits. For example, it may deny claims for pre-existing conditions and, for musculoskeletal injuries, its Program of Care could limit therapy to eight weeks.
However, he said, the WSIB is an enlightened benefits provider in general and said the agency will be an important partner in taking a holistic approach to the opioids problem.
“The WSIB is a very small contributor to this problem,” said Tiano. “They didn’t cause the problem. Are there unintended consequences? Yes. And the fix on the WSIB side can be done.
“This is not a WSIB problem. This is a problem that we have throughout the prevention and compensation system.”
Asked for comment, the WSIB issued a statement saying the WSIB has been a leader in helping to reduce reliance on narcotics, with its policies informed by the 2017 Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain.
“Our funding approach is based on current evidence and driven by a desire to help curb the opioid crisis and regular engagement with the person’s treating physician,” said the statement.
Tiano said the next steps for the Building Trades and their collaborators would be to attack the “low-hanging fruit.” First, there will be a musculoskeletal survey to identify broad hazards in construction workplaces; a meeting of participants is scheduled for this week.
Tiano said preliminary plans for 2024 could include further refining of the Total Worker Health approach by, for example, reaching out during Repetitive Strain Injury awareness month in February. Data searches and collaborations across the country could lead to a possible scheduling of the next phase of workshops at the 2024 Building Trades convention.
Tiano’s report stated a full range of interventions related to the ergonomics of construction must be pursued.
There won’t be quick fixes, he said.
“There’s no magic wand. You need to look at multiple actions across multiple continuums.”
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