Men in the trades are on the frontlines of the opioid crisis.
A recent warning issued by officials in the Fraser Health region of the Lower Mainland said men ages 19 to 59 who work in the trades are an overrepresented section of the population considered at risk of a fatal overdose from opioid use.
The province of British Columbia declared overdoses a public health emergency in April 2016.
According to Fraser Health, overdose rates are higher than ever before.
"The B.C. Coroners Service reported that there were 922 illicit drug overdose deaths from January to December 2016 in the province. Overdoses are occurring in all sectors of our communities, at all ages across all social statuses," stated a Fraser Health information page on the overdose crisis.
Fentanyl, a pharmaceutic used medically as a pain killer or anesthetic is widely regarded as the cause of the increase in deaths due to overdose. Fentanyl is a synthetic opioid and is 50 to 100 times more toxic than morphine.
"As this hidden epidemic is disproportionately affecting men between the ages of 19 and 59 in trade industries, we are engaging with groups outside the health care sector, such as employers, technical schools, and sports associations, which may be able to assist in identifying and supporting individuals who are struggling with substance use," the Fraser Health release stated.
"When we see surges, we send out a warning," said Fraser Health chief medical health officer Dr. Victoria Lee. "Coroner reports go back a year to when the emergency began, but we saw in the reports that over 70 per cent of overdoses were dying of overdoses in private homes."
There is much in the way of evidence-based harm reduction practices for the homeless population, Lee said, but not for those dying in residences.
"In the construction industry, there's a higher rate of injury than in other industries and doctors are too quick to prescribe a person medication when there could be other options," explained BC Building Trades executive director Tom Sigurdson. "Some people are quick to find addiction, and once on the drug, they'll get a fix any way they can."
But while the industry has systems in place to prevent both injury and deal with addiction, Sigurdson stressed the importance of a realistic approach to the problem.
"Whenever we can reduce injuries that's a good thing. Ideally, every workplace is an injury-free zone, but we live in the real world and there will be injuries," he said.
Construction's male-dominated culture could be another factor behind the disproportionate amount of overdoses suffered by men in the trades, he added.
"There's lots of testosterone in the industry. If you're hurting, you pull up your bootstraps and get back to work," Sigurdson said.
Lee echoes his comments.
"The deeper social issue is that men are not allowed to be vulnerable, so it's tougher to talk about problems they have with substance abuse and they can self-medicate," Lee said.
"There is a culture of 'work hard, play hard' sometimes because of the age group and demographics involved."
In addition to higher rates of injury in the construction industry, young people tend to be more prone to injury and older workers take longer to recover.
British Columbia Construction Safety Association (BCCSA) director of operations Tammy Oliver noted the overrepresentation of men in the study is not a new problem.
"They are definitely troubling statistics, but this is not new. Men have made up about 70 to 80 per cent of opioid deaths for some time," Oliver said.
The BCCSA's main priority is to assist in emerging worker safety issues such as the opioid crisis, she added.
"We don't have the resources to deal with workers individually, but we can provide contact information for them to get help," Oliver said.
She added the BCCSA has also held seminars in the past concerning substance abuse in the construction industry.
The Construction Labour Relations Association of BC (CLR) has developed a substance abuse testing and treatment program policy jointly with the BC Building Trades that applies to all union construction workers in B.C. The objective of the policy, stated on the CLR website, is to "enhance workplace safety for union workers and to provide treatment and rehabilitation services for workers with substance abuse problems."
CLR vice-president of government relations and HR services Dave Earle administers CLR's substance abuse testing and treatment program and agreed substance abuse in the trades is not a new phenomenon.
"We've had a rehabilitation program in place for 30 years. It's a problem we've tried to address for decades, but the penalties for failure are now much more severe," Earle said.
"We don't do a good job of assisting people living with pain. We have to explain that pain and suffering is a way of life. There are better ways to manage pain than medication, but they aren't simple. We have to change the conversation on substance use. 'Just say no' doesn't cut it."
Fraser Health is connecting with employers, technical schools and sports associations to provide opportunities for intervention within the trades and the workplace, Lee added.
"We're looking at pain management in terms of opioid stewardship, as well as working with physiotherapists, massage therapists and chiropractors," Lee said.
Fraser Health maintains an information hub regarding overdoses and the ongoing fentanyl crisis at fraserhealth.ca/overdose and questions can also be emailed to firstname.lastname@example.org.