Rates of opioid toxicity deaths highest among construction and trades workers, study finds

Between 2018 and 2024, those who worked in construction and trades made up approximately one-third of deaths from opioid toxicity in Ontario where occupation was known, according to a report released this week by the Ontario Drug Policy Research Network (ODPRN). In addition to highlighting the toll of opioid toxicities in this sector, the report also draws attention to their impact among people across various occupations.

“People across every walk of life and every kind of job are affected by opioid toxicity, though the circumstances behind those deaths and how we might prevent them are nuanced and often differ from one workplace to the next,” says Shaleesa Ledlie, senior research associate at the ODPRN, a research group based at St. Michael’s Hospital and Unity Health Toronto and lead author of the study. “It’s helpful for us to understand who is most affected and how, so we can tailor approaches and services to the specific needs of different people and workplaces.”

The ODPRN team used population-based health care data from ICES, a nonprofit research institute that uses health data to produce knowledge on a broad range of health care issues. They used the data to examine trends and circumstances surrounding opioid toxicity deaths among different employment sectors in Ontario from Jan. 1, 2018, to Dec. 31, 2024.

During this period, there were nearly 16,000 deaths in Ontario from opioid toxicity; approximately 3,500 of these people had an occupation included in the coroner’s report and were included in the study. The study showed that different employment sectors were affected differently by opioid toxicities, with varying rates, trends over time and circumstances of death.

The construction and trades sector was particularly affected, with not only the highest death rates but also increasing rates over the study period.

“Our findings show that opioid-related deaths are not affecting all workers equally. Specifically, people working in industries such as construction, trades and mining experienced the highest rates of opioid-related deaths, with these deaths increasing considerably during the COVID-19 pandemic and remaining elevated over time,” says Tara Gomes, senior author of the report, a scientist at MAP Centre for Urban Health Solutions at St. Michael’s Hospital and ICES, a principal investigator of the ODPRN, and a professor (status) at the Leslie Dan Faculty of Pharmacy at the University of Toronto.

“The reasons for this are likely multifaceted, including these occupations being male-dominated fields where people are at risk of injuries, undertreated pain, difficulty accessing treatment and barriers to discussing substance use.”

Andrzej Celinski is a study co-author and co-founder of the Reclaim Collective, an organization of people with lived experience that provides education and consulting services related to issues such as substance use, harm reduction and housing insecurity.

Celinski has previously worked in the construction industry and is currently a board member for the Workers for Ethical Substance Use Policy. He says, based on his lived experience, the high rates of toxicities among workers in construction and trades were not surprising and that workplaces could take on a greater role in harm reduction.

“Drug use in the workplace, specifically construction and trades, doesn’t get addressed very well. It’s a workplace shaped by physically demanding work, injuries and chronic pain, and a culture where asking for help can feel risky. The workplace needs to feel safe enough for people to ask for support before things become too difficult to manage on their own and they feel they have nowhere else to turn,” he says. “Making naloxone, overdose training or awareness and connections to care more prominent in the workplace would help to reach people who might not access other traditional services, but this isn’t happening in most cases.”

Analysis points to need for tailored programs and services that address underlying factors

Other occupational sectors were also significantly affected by opioid toxicities. People who worked in manufacturing, hospitality and retail each made up close to 10% of deaths.

Rates of death among people who worked in civic and government services (e.g., police, military personnel and firefighters) increased over the study period, while rates for manufacturing and transportation, warehousing and equipment operations were consistently high. The researchers note that these roles are often physically demanding, with high rates of workplace injury, chronic pain, mental health challenges and a lack of support to manage transitions from pain medications—all of which may increase risk.

Conversely, rates for other sectors—notably hospitality—peaked during the first years of the COVID-19 pandemic and have since decreased.

Approximately one-third of people who died were unemployed at the time of death, although the hospitality sector had a higher proportion of unemployment at the time of death. The researchers say this may reflect the impact of temporary layoffs, particularly in the hospitality sector during the pandemic; it may also suggest that loss of employment and transitions from the workforce because of injury, pain or mental health challenges may increase people’s risk of substance-related harm.

While most deaths were determined to be accidental, three sectors—civic and government services, health care, and administrative, financial and support services—had higher proportions of deaths by suicide.

“Taken together, these findings reinforce the need for programs and services that are tailored to the diverse needs of people at risk of opioid-related harm,” says Gomes. “While workplace-based prevention, education and support remain important, with most opioid-related deaths occurring in people’s homes, efforts must also extend beyond the workplace and include reducing stigma surrounding substance use and improving access to treatment and harm reduction services to better support people across the settings in which they live and work.”

For example, underlying structural factors such as housing instability, income insecurity and insufficient access to pain management and mental health care can all increase the risk of substance-related harm. As a result, many different harm reduction and treatment approaches are needed to keep people safe and address the underlying pain, trauma or mental health challenges people experience.

“Toxicity deaths are not happening in a vacuum or to a specific group of people. Not all overdoses are happening among folks who are unhoused or in public where people can see. Oftentimes, this is happening behind closed doors and in people’s houses, often when they are alone, so it’s invisible to the population,” says Celinski.

“We need to look beyond individual behavior and address the conditions that shape folks’ ability to access support.”

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