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Health, Science, Environment

Missouri Construction Workers Face Frequent Injuries, Often Prescribed Opioids

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File photo / Shahla Farzan
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St. Louis Public Radio
An analysis from Washington University finds a large share of construction workers in Missouri, southern Illinois and Kansas are being diagnosed with chronic muscle and joint injuries each year, and many are prescribed opioid painkillers. "It’s a very severe problem that starts with the back injuries, the shoulder and wrist injuries,” said Len Toenjes, president of the Associated General Contractors of Missouri.

St. Louis plumber Amanda Dace still remembers the moment the drill slipped from her hands, nearly two decades ago.

Dace, who was in her mid-30s and training as an apprentice, was cutting through a board to install a water spigot when she lost control of the drill, injuring her wrist. “All it took was a second,” she remembers. “It happens that fast.”

By its nature, construction work is often intensely physical — bending, lifting, kneeling — and muscle and joint injuries are common, even on the safest job sites. An analysis from Washington University finds a large share of construction workers in Missouri, southern Illinois and Kansas are being diagnosed with these injuries each year, and many are prescribed opioid painkillers.

Construction work is more physically demanding than the body can handle, said Ann Marie Dale, Washington University epidemiologist and study co-author, and workers may turn to painkillers as a quick fix.

“They don’t get paid if they don’t go to work,” Dale said. “Individuals need to find ways to manage the pain,” especially if they’re not able to take time off for physical therapy and other alternative treatments.

Opioid painkillers are also easily available on many job sites, and it’s not uncommon for workers to share them with each other, Dale said.

But the ubiquity of opioids within the industry is putting workers at risk. Construction workers have the highest death rate due to opioid overdose of any occupation in the U.S., according to a 2018 federal report.

Chronic injuries common among workers

Dale and her colleagues analyzed union health insurance claims from 19,909 construction workers in Missouri, southern Illinois and Kansas from 2015 to 2018, along with pharmacy records on prescriptions for opioids and benzodiazepines.

They found nearly 43% of workers per year were diagnosed with chronic muscle or joint injuries, also known as musculoskeletal disorders. Of these, 1 in 4 received a new opioid prescription.

Construction workers with chronic musculoskeletal injuries were more than four times as likely to become dependent on opioids, compared to other diagnoses, like dental visits and kidney stones.

Construction workers have the highest death rate due to opioid overdose of any occupation in the U.S., according to a federal report.
Angela Hsieh
Construction workers have the highest death rate due to opioid overdose of any occupation in the U.S., according to a federal report.

But the prescription itself was also a key factor, with high-dose opioids and prescriptions lasting longer than a week associated with a much higher risk of developing an opioid use disorder.

The “sad truth” is doctors aren’t doing patients any favors when they prescribe opioids for chronic pain, said Brian Gage, Washington University professor of medicine and study co-author.

“There's this irony that opioids are very effective in the short-term for pain relief, so people often seek them out,” Gage said. “They’re not really effective for long-term pain, and they can be very difficult for workers to stop once they've started taking them.”

Physicians have been trying to ease their patients’ discomfort with painkillers for years, Gage said, turning to longer-duration prescriptions and higher doses. But in hindsight, he said, “we realized we were contributing to the problem — unknowingly, but we were.”

Meanwhile, Missouri remains the only state in the U.S. without a prescription drug monitoring program, which normally triggers an alert if a patient has multiple opioid prescriptions. Proposed legislation died in the state Senate last May, though legislators may reconsider the issue this year.

Growing industry awareness

Opioid misuse in the construction industry is not a new issue, said Len Toenjes, president of the Associated General Contractors of Missouri, but in the past few years, people have started taking it more seriously.

“It was something people really didn’t pay a lot of attention to,” Toenjes said. “It was really under the radar. But it’s a very severe problem that starts with the back injuries, the shoulder and wrist injuries.”

Toenjes began working as a carpenter in the mid-1970s, during what he refers to as the “pre-OSHA” days. Some of the things he did to get the job done as a younger worker, he acknowledges, are not things he’d do today.

“It takes a lot of extra education for folks to realize they’re not going to be 25 or 30 years old forever, that they’re not Superman,” he said. “You may not feel it the first time or the second time, but maybe the 60th or 70th time, all of the sudden, your body reaches a certain tolerance point.”

For Amanda Dace, the St. Louis plumber, the work comes with its share of aches and pains. These days, the 51-year-old works mostly on commercial job sites as a journeyman union plumber for Local 562, lifting pipes overhead and kneeling to hook up sinks and toilets.

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file / Shahla Farzan
A volunteer carpenter helps build a new home in Wildwood in 2018.

The union is serious about safety training and teaching workers how to care for their bodies, she said. Still, years of climbing ladders have taken a toll on her knees.

“I have a lot of knee pain,” Dace said. “If it’s a short drive home, it’s not really that bad. But if it’s a long drive, by the time I get home, it’s hard to get out of the car.”

Sometimes, Dace feels like the mom of the job site, reminding younger co-workers to be careful and take it slow. Opioid use in the industry is definitely a problem, she said, and can start even after a seemingly minor injury, like a strained back or a twisted ankle.

“I tell some of the guys, ‘Just go find out what the problem is,’” she said. “‘Don’t just keep covering it up with the medicine. Go get well.’”

Still, despite greater awareness of the risks of opioid dependence, chronic injuries will continue to be an issue unless the industry invests in new ways to reduce the physical demands of the work, said epidemiologist Ann Marie Dale.

“The workers themselves just know their bodies are going to be torn up by the process, and they hope they can last as long as possible,” Dale said. “Our society should not be treating human bodies the way that we do.”

She hopes technological advances, such as lighter-weight materials, along with greater use of alternative pain treatments, will help curb this problem in the future.

Follow Shahla on Twitter: @shahlafarzan

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