Perhaps you read about the NIOSH study published in late August that found construction workers die of drug overdoses (not while on the job) at a rate six times higher than the general work population. Heroin was the main killer, followed by prescription opioids. 

Of course construction workers face risks every day. A fall from scaffolding or bad knees from years of cement work can lead to prescriptions for opioid pain medication, which in turn can lead workers down a rabbit hole into pain pill addiction, and then to cheap heroin, usually laced with fentanyl, an even more powerful synthetic opioid.

In 2017, it was reported that Ohio construction workers were seven times more likely to die of an opioid overdose than any other occupation. Earlier this year, a study found 962 construction workers died from opioid overdoses in the Midwest in 2015. In Massachusetts, nearly one quarter of workers who died from opioid-related overdoses between 2011 and 2015 worked in construction. 

This is how it can happen. A 22-year-old construction worker from Maryland traveled to Brooklyn, NY, for a birthday party in October, 2017, according to the New York Daily News. He and his 44-year-old father went out for a late-night smoke. Both died of apparent heroin overdoses.

The persistence of pain

Drug overdoses in construction work are the tip of an iceberg. Nearly one in six workers is in pain nearly every day, according to the Centers for Disease Control and Prevention (CDC). A 2017 CDC study found 15 percent of the U.S. workforce grapples with long-term pain, reporting having pain every day, or most days, for the past six months, according to the study.

Past studies indicate chronic pain is a problem for a significant portion of U.S. adults. A 2015 report from the National Institutes of Health (NIH) found that 25 million adults experienced chronic pain, and nearly 40 million U.S. adults — 17 percent — have had severe pain.

“The number of people who suffer from severe and chronic pain is striking,” Dr. Josephine P. Briggs, director of the National Center for Complementary and Integrative Health, said at the time of the study’s publication.

Painful occupations

If you employ laborers; freight, stock and material movers; heavy and tractor trailer truck drivers; janitors and cleaners; nurses’ assistants; police officers; maintenance and repair workers; stock clerks and order fillers; construction laborers; and registered nurses, chances are you have people working in pain. These jobs suffer the highest number of injury and illness cases requiring days away from work, according to the Bureau of Labor Statistics. 

But cases of lost workdays are very rare, actually. BLS reported 892,300 cases involving days away from work in 2016. The private industry incidence rate for these most obvious cases relating to pain (eight days away from work was the average) was 91.7 per 10,000 full-time equivalent workers in 2016.

That equates to 0.0092 percent of workers – ten workers out of 10,000.

Painful presenteeism

It’s much more likely workers will show up at the job and suffer through their pain – maybe with the help of prescription or over-the-counter pain relief, perhaps not. Many of the jobs with the most lost-workday cases are low-paying. There is often a lack of job security and sick pay. “Workers who will be unemployed if they don’t show up might very well decide it was better to use opioids than to risk losing their jobs,” said one researcher.

Drugs are readily available on job sites, according to experts. But there is a history of sucking it up and working through pain that goes beyond easy access to pills. Blue collar culture has always valued toughness and stigmatized seeking help. Working through pain is as old as the industrial age. Manual laborers see themselves as rough working men and women, strong tough guys, who get hurt, patch themselves up and get back on the job. 

But you needn’t be a manual laborer to endure a painful pace of work. Elon Musk, the CEO of electric car maker Tesla, recently said in an interview he could not slow down and had spent the past year in excruciating pain.

Pain’s broad parameters

According to the National Institutes of Health, common forms of chronic pain can be related to osteoarthritis, low back pain, fibromyalgia, headache, and rheumatoid arthritis. Stress or a hectic lifestyle can also push pain levels higher.

To be sure, pain is not limited to fractures, carpal tunnel syndrome, amputations, tendonitis, sprains, strains and tears. Dr. Jenna L. Walters, a pain management specialist, told Healthline that chronic pain for employed Americans is not necessarily tied to a physically demanding job. “We see a lot of patients in our clinic who sit at a desk job,” she said. “Sitting all day, our bodies weren’t meant to sit in a desk chair.”

Benign neglect

Many employers don’t spend much time or money on treating employees who  are experiencing chronic pain. Many painful disabilities are not visible, and any number of workers will hide their pain due to the stigma of seeking help or fear of losing their jobs. As mentioned, lost workday cases are rare.

Some employers are more cognizant than others. Some administer wellness programs and make accommodations and workplace adjustments for employees in pain. Employees who feel supported are more likely to access all available aid, feel better, and perform better on the job.

But most employers do not recognize how crucial their roles are in helping to manage the prevalence of pain in the United States. They view chronic pain as a personal problem, rather than a work issue. Until those views change, employees are left on their own to suffer and deal with working while being in pain – often by risking addiction and overdosing on prescription painkillers.

—  Dave Johnson, ISHN Editor,