Introduction: The story of how the Keystone Contractors Association became a respected authority in the opioid epidemic goes like this: in late 2016, early 2017, the KCA embarked on creating a strategic plan. This activity included trips around the state to get to know the contractor members better: learning about their strengths, weaknesses, challenges, etc. During these conversational meetings, a reoccurring topic kept creeping into our talks – opioids are wreaking havoc on our industry and communities. The KCA Board was in agreement that we have a major problem and they turned to me to find solutions. Not knowing where to turn for help, I asked a bunch a industry friends for advice. The best advice I received was from my former co-worker Bob McCall who said I should start with the National Safety Council and see if they can help. The KCA started with the NSC and here we are four years later still working with them to help in the battle against drug and alcohol addiction. In this episode, my friend Rachael Cooper of the NSC talks with the Building PA Podcast about opioids.
To listen to the entire episode visit: Opioids & the Pennsylvania Construction Industry.
Jon O’Brien (00:00):
Hello, and welcome to the PA construction industry podcast recorded right here in the Commonwealth of Pennsylvania. I am one of the hosts, Jon O’Brien from the Keystone Contractors Association.
And this is Chris Martin with Atlas Marketing, where we tell stories for people who build things.
Awesome. Glad you’re with us today. I hope you’re ready for another episode here, Chris. This is a very timely very important topic for not only for both of us, but for the entire industry. So this is great. Yeah, absolutely. The topic is something very near and dear to the construction industry and the KCA members. So about three and a half years ago, I was hired by the KCA and the KCA is located in central PA. The headquarters is Harrisburg and I left Pittsburgh and this was a new membership of construction companies for me.
Jon O’Brien (01:02):
And the first thing I wanted to do was really find the strengths and weaknesses of these members and get to know more about them and their challenges. There was a reoccurring issue that kept popping up throughout these construction companies. And it was the opioid issue and how it is drastically affecting, you know, their own workforce and their communities. And it’s just tearing families and communities apart, and the KCA wanted to do something about it. So, I started making a bunch of calls and contacts to industry friends, and everyone said the same thing. You got to go to the National Safety Council, they have the premier resources. It’s a great educational outlet for information. And I’m just thrilled and excited to have Rachael Cooper from the National Safety Council with us today to talk about opioids and, and yeah, I’m really excited to welcome her to the show right now.
Rachael Cooper (02:03):
Thank you guys. Thank you for having me.
Jon O’Brien (02:07):
Yeah. So, as I mentioned, the topic today is opioid awareness and the effect on the industry. Can you kind of give us maybe your background and kind of lead up to you know, your involvement in, on this serious issue?
Rachael Cooper (02:22):
Absolutely. So, thanks again for having me. My name is Rachael Cooper and I am the senior program manager and subject matter expert on opioids for the National Safety Council. My personal background is one that’s based in both international and public health. So, I started working on the opioid epidemic abroad when I was living in France several years ago, I have moved back to the States and I have worked both on the front lines, doing a lot of programming, getting people into treatment and getting people to support that they need people who have an opioid use disorder. And then now I’m working for the National Safety Council. And what we’re primarily working on right now is the intersection of opioids and how it impacts the workplace. So, when I say workplace, I mean, both employers and employees. So that is how our programming came to Jon’s ears.
Rachael Cooper (03:19):
And a lot of what we do right now as pertains to opioid awareness is really about realizing that this is an issue that we can all impact. This is something that we can all learn about that we can all change. The opioid crisis is complex, and it has many different faces and many different storylines, and it impacts us all differently, but we can support ourselves and help ourselves and help our neighbors and our communities and our colleagues and our coworkers by learning more about the issue and really increasing the education and awareness about the issue.
Jon O’Brien (03:53):
Great. Great to have you on the show here and on behalf of the KCA membership, thank you for all the resources you guys have supplied us, the NCS supplied us. They’ve been extremely helpful for the employers. You know, we get the stickers on the insurance and medication cards. That’s been awesome. It’s been chronicled in media outlets and others, of course you got the resource guide just came out.
Rachael Cooper (04:23):
Yeah. Yeah. Let me give a, I can talk a little bit about the things that you know that we’ve put out. So, the stickers that you mentioned, just to clarify, those are the warn me labels and warn me labels are intended for anybody who uses a pharmacy, right? So, anybody who receives a prescription, which is most of us, one thing that we know is that oftentimes when you’re prescribed a medication, you’re not exactly sure what it is, right? You might be prescribed something and it doesn’t sound like something you’ve heard of. We know that’s also very true with opioids. A lot of us are very familiar with say oxycodone or Percocet or Vicodin. Those names are very familiar to people, but there’s ones that are equally unfamiliar, such as Tramadol. Tramadol is also an opioid for example, or some of the generic names that we might not recognize as an opioid, what a warning label does is it, you stick it on your own pharmacy loyalty card or your insurance card or whatever.
Rachael Cooper (05:21):
And it says, opioids warn me. And it’s a reminder to yourself to ask your doctor for questions, which are provided to you about, you know, am I being prescribed an opioid? Is there an alternative, if there isn’t an alternative, how can I take this safely, et cetera, et cetera. And it’s a reminder, not only for you, but when you present your pharmacy card to your pharmacist, it’s a reminder for them as well. So, this is one of those tools that we thought was really useful in the workplace. And there’s a lot, like you said, it’s been published in the media because we give them out in little cards of four. So not only do you put it on your own pharmacy card, you can take it home for your family, or you can pass it to friends and they are free and can be ordered on our website at www.nsc.org/takeaction.
Rachael Cooper (06:05):
So that’s one of the really concrete tools that we’ve put out the second tool. And this is really about engaging businesses and understanding the impact that the opioid crisis has had on the workplace is our substance use cost calculator and the substance use cost calculator takes your organization’s size it’s industry and the state that you’re in and uses a variety of sources to debt of data, to calculate the financial impact that the opioid crisis has had on your workplace from turnover to absenteeism, to increase health care costs, to workers’ compensation costs. This tool pulls together all of that information so that you can see the cost of substance use, not just opioids, but also including alcohol cannabis, et cetera, is having on your workplace. It also shows you how much money you can save by supporting employees through recovery. The third tool that was just mentioned is the NSC opioids at work employer tool kit, and the employer toolkit is a set of resources targeted at four main audiences, HR professionals, safety professionals, managers, and supervisors, and employees themselves.
Rachael Cooper (07:23):
We came to the conclusion after serving several hundred organizations across the country that all four of those groups are necessary to create a comprehensive program to address opioids in the workplace. Opioids have a safety impact. They’re in impairing medication. They’re impairing when they’re taken as a drug, some people may show obvious signs of impairment, many people won’t. How do we recognize those safety risks? How do we understand the business risks, again, talking about the substance use cost calculator and those costs. How do we understand the human component, the culture component, when there are people in the workforce who are struggling with drug use or an opioid use disorder that impacts the workforce and how the workforce feels, the health of the workplace in general, as well as the individual health of the employee. And then of course, education resources for employee themselves to have a better educated, more aware workforce. So that opioids at work employer tool kit came out recently in September of 2019. And again, it has a set of it’s four sets of documents and tools that you can use to in your workplace to really evaluate where your workplace is at and re-addressing this and give some key action steps that can be really helpful when addressing the opioid crisis in the workplace
Jon O’Brien (08:40):
Concerning the warn me stickers. There is another benefit that we realized. And I don’t know if other companies that you talked to realize this as well, but as far as the actual handling of the sticker from the employer or employee, in some cases, some contractors told me there was kind of a, you know, a bond was built, you know, relationship was improved. Now their employers showing they have put this on you, I care about you and take some home to your family. I care about your family too. So that was an absolutely touching feedback we heard there. So, yeah.
Rachael Cooper (09:15):
Yeah. We hear similar things. I think that one of the things that is really critical is when we talk about the opioid crisis or the overdose epidemic, or any of the intersecting parts, is that you can’t overstate the impact that stigma has when people are trying to seek help. When people are trying to figure out how to handle an opioid use disorder or a substance use disorder, either with themselves or within their family, right? It might not be, you know, your employee, it might be their spouse or their child or another family member, or a dear friend who’s dealing with this, which also is stressful and can really impact their presence in the workplace. And if they’re on your healthcare plan, of course, there’s costs associated there as well. But if people feel like they will be judged, if people feel like they will lose their job, if people feel like they aren’t safe in disclosing this to a coworker, a manager, an HR professional, anybody, they’re not going to say anything, which means that we’re not going to learn about it, and then we can’t help. So like you said, that first step by saying being proactive and saying, I care about this, I care about you is certainly one of those unspoken things that’s critical for the success of any opioids at work program implementation.
Chris Martin (10:38):
So Rachel, you mentioned the human and cultural impact of the opioids epidemic. I’m sorry. I left that out. What are you seeing from not only from the national level, but more from like more specifically to Pennsylvania, how is that impacting contractors and, and overall the industry as it relates to Pennsylvania?
Rachael Cooper (11:04):
Sure. So, there’s a lot of information out there about how the construction industry is one of the hardest hit industries in terms of drug use in general. Late last fall NYU came out with a study that showed that construction workers were the most likely to use opioids and cocaine. So, there’s a lot of different reasons for that involving, and some of them are specific to Pennsylvania, some of them aren’t for example, that Eastern seaboard area, Pennsylvania, you know, even the Massachusetts, Connecticut, and then a little bit into the Midwest, including Ohio, West, Virginia, et cetera, et cetera, these are all very hard hit areas in general, right? Access is definitely part of this conversation areas where opioids are less prevalent for in the plain States like North and South Dakota, Wyoming, et cetera. There’s a much lower level of opioid use due to the access component. But when you’re in a place where access is pretty high, where the capacity to access these substances or any substances is higher, obviously that does also equate to more people using them. So that’s certainly part of it, but we also know that there’s certain factors in construction and also mining and extraction industry.
Chris Martin (12:22):
That they’re… I’m sorry,
Rachael Cooper (12:23):
Hazards, you know, falls injuries from overexertion being stuck in our crop by heavy machinery injuries from repetitive or strenuous work, et cetera, leads to pain. And the most frequent reason that people misuse opioids is to treat pain. This is why most people misuse opioids, most of the time, you know, you think that we’re talking about physical pain, there’s certainly a mental pain component to it as well. But oftentimes, especially when it comes to chronic pain, there’s a lot of research that has yet to be done in terms of how to best treat chronic pain. So people self-medicate, they don’t know what else to do. Sometimes it’s opioids, sometimes it’s marijuana with opioids. Of course, once you start to develop a dependence on the medication, then it can be really, really difficult to wean yourself off. And when you’re continuing those movements or those motions, or those repetitive motions that can really exacerbate injuries or pain, or when you’re still putting yourself at risk, then people aren’t going to understand how to get themselves off these medications.
Rachael Cooper (13:29):
So that’s one of those, you know, those factors with the construction industry, that’s really important to consider. Another thing that we know from a variety of sources is that when people don’t have stable, sick time, when they are not sure how to help, they’re going to be employed you know, in the next week, or if they’re, they’ve only got a month and people tend to push through their pain, right. As opposed to taking time off and going back, they tend to push through it because they need to so that, you know, they don’t miss work so that they can come back to work. So oftentimes these are the kinds of, this is the intersection that we really see here is this, this high impact, higher risk injury for injury, as opposed to, for example, an office. I mean, I work from home, right? My risk of injury is generally me slipping on my hardwood floors.
Rachael Cooper (14:18):
Right. It’s very, very different which I do by the way, because, you know, I shouldn’t be wearing, but sometimes I don’t wear shoes and sometimes I’m wearing socks and when I slip and I’m like, well, that was great. But in general, you know, when, when you’re looking at those people will go to really extreme lengths to hide their, their drug use as a general thing, they don’t want to get fired. And they need, they need their job. Right. And, and especially when it’s a seasonal thing, we see this in the fishing industry as well. Well, another high impact industry where it’s seasonal, where people might get hurt three weeks in, but they’re not going to stop because they can’t. So this is, you know, one of those, a similar situation in that, in that case,
Chris Martin (14:59):
You know, it’s funny Rachel, you mentioned, you know, slipping on the hardwood floors and stuff, but I had surgery a year and a half ago minor surgery, nothing crazy as I was getting discharged, the nurse was, you know, standard procedure going through everything. And she handed me a prescription and it was for Oxycontin and she looked at it before she handed it to me. She, she looked at it again and she goes, Oh, hold on a second. I need to check on this. So she walks, goes, checks with the doctor, comes back. It was, you mentioned, I’m bringing this up because you mentioned access. The prescription was for a hundred Oxycontin. Wow. And like, my wife looked at me and says that there’s no way we’re going to, you’re never, ever going to use that. And I said, exactly. And the nurse at least had the foresight to go and at least confirm, are you sure you really want to do this?
Chris Martin (15:55):
And then when I went to the pharmacist and I said, give me 10, I don’t need a hundred. That’s ridiculous. You know, but to your point, there are so many times when people look at it and say, well, Hey, I got a hundred, I’m going to use all. You know, that isn’t really helping anything, but the access side of things I think is, is another part of it. You know, the, the pain management world of the medical industry is always trying to help with that. But at the same time, they’re really not helping at all.
Rachael Cooper (16:28):
Yeah. And I think that, you know, from a personal perspective, what I’ve learned is, I mean, so I broke my leg a few years ago out on the West coast. And then we had to drive home and I live in Madison, Wisconsin, and it was a long drive obviously. And they gave me a bike and then I took it for a day because it made me sick. And then I was sick and had a broken leg. And I was like, that’s a bad combination too. So we’re just not going to do that. But those just, they just sat in my medicine cabinet. And that’s a pretty common thing where people forget about it, or they specifically choose to keep it, because what if they need it down the road, especially for people who are under insured or who aren’t sure where their next prescription is going to come from, or if they’re going to be able to get the support that they need, that a lot of that can happen. And when people are going to elect to say, no, I’m going to keep these in case I need them, because what if I can’t get them when I do need them?
Jon O’Brien (17:18):
Yeah. It’s kind of scary to think that that is that’s the mentality, but you understand it too.
Rachael Cooper (17:26):
Right. And I think that’s one of those really critical moments where we know when, when you think about it and you’re like, I just wish people wouldn’t do that. Of course you do, but it needs to, and this is where we have this. We talk a lot about a multifaceted response here, right? This has to be about more than just personal responsibility to get rid of your medications. You know, people have to be able to access what they need for pain management, including possibly, you know, if you know, your doctor says that actually we want to put you in occupational therapy, or we want you to go to chiropractor once a week or whatever they end up saying. Oftentimes, I mean, it’s a lot easier and it’s a lot faster to take a pill, right. It’s just easier.
Rachael Cooper (18:07):
It takes less time. You don’t have to take time off of work. You don’t have to do something that maybe you’re not comfortable with. You know, people who are scared of needles, aren’t going to want to go to acupuncture, that kind of stuff. Right. So, you know, it’s part of, it’s a multi-sectoral response and that not only do we need to increase the access for non opioid pain management options, but workplaces have to be able to give people the time to go access those options. And also to say that, Hey, I know that, you know, maybe your recovery from your injury is taking a little bit longer than expected, but we want you to be back here and fully healthy as opposed to back here and partially healthy and still trying to self medicate to be able to come back to work. So there’s definitely a several different levels of engagement here.
Rachael Cooper (18:54):
And we have to rely on the treatment industry to increase access to treatment. And we need to work with, you know, the prevention organizations to, to work on some of the more in depth prevention mechanisms. And there’s so many different capacity factors here, and we don’t have the capacity to do all of them. So, you know, this is where we talk about teaming up in your community. And Pennsylvania has a ton of resources. It’s one of the States that has a lot of different resources across the state from Philadelphia to Pittsburgh and everything in between where it’s the state has been really proactive, which is a really pretty cool thing because there’s definitely States where it’s not the case. So everything from harm reduction organizations to you know, the criminal justice world of social services to employment stuff, there’s some really cool stuff in Pennsylvania as a whole.
Jon O’Brien (19:42):
And recently our governor, Tom Wolf, gave his budget address and he was commenting how overdoses are down in Pennsylvania last year for the first time in so many years. And they really credit all the outreach that these organizations and companies do. So I just wanted to echo your comments as a man, he does do a great job, but like our governor said, it’s not done until we’re down to zero, so we just gotta keep it up.
And you said something Chris there. Sorry. Sorry. No, that was a really good point there, Jon.
So Rachel, my question for you is what’s coming next. What’s the National Safety Council doing next to continue to build off of all the great things that have happened?
Rachael Cooper (20:28):
Sure. So a couple answers to that question. So one is that we do recognize that a lot of the resources that we have built and that NIOSH has built that other industries or other organizations have built really tend to focus on organizations who are not only really advanced in their safety, but also have a lot of resources at their disposal. So for example, when I say that, one of the things that I mean is oftentimes we talk about making sure that employers structured their benefits plans to not only cover to not only cover alternative pain management mechanisms of non-opioid pain management mechanisms, but also to cover medications for addiction treatment and, you know, behavioral health therapies, et cetera, et cetera. You can’t do that. If you don’t have an employer health care plan, if you’re a small organization, if you’re a small business, right, this is not an option for you.
Rachael Cooper (21:26):
You know, you can do the best you can internally, but if you’re not the one providing and negotiating with your health insurance providers, then you’re at their whim of the ones that your employee chooses to buy or to not buy for that matter. So that’s one of the things that we’re really diving into is ensuring that small businesses have the resources that they need because this impacts small businesses as well. We know that the majority of opioid overdoses that happen on the job happen in small businesses, small businesses are less likely to drug test. They’re less likely to have, you know, some of the policies in place that we want. So how do we work with those businesses to get them to them point where, you know, they can also take these, these actions. We are also understand of course, that regardless of the size of the business and regardless of the industry, that there’s different levels of maturity, some people are still learning about this.
Rachael Cooper (22:29):
Maybe it hasn’t hit them very hard yet. You know, the West coast is just starting to be hit by the fentanyl crisis. It’s different. It goes East to West here. So the East coast is starting to see a rise in stimulant use after the fentanyl use the West coast just now is starting to really get hit with the fentanyl. So it depends on where you are, right? So understanding that those particular caveats is really important and understanding that there’s always going to be organizations that are starting from scratch. So the more that we know and the deeper we go into this and the more mature organizations that we partner with closely that we really work with become, you know, as they do, as they work along the entire spectrum of prevention and treatment and recovery and all those different recommendations about how to navigate opioids in the workplace, how they implement these programs, how they learn about it, what works, what doesn’t really taking, what we learned from the implementation that people are doing right now, and helping create a framework for businesses who are going to be coming a little bit later.
Rachael Cooper (23:30):
We also understand, of course, that this is a pharmaceutical drug issue. It’s not just opioids. I live in Wisconsin, we were up in Wisconsin, Northern very Northern Wisconsin. Last May, and all we heard about was alcohol and because that’s what the issue is up there. So it’s important, of course, at all times to really understand that while we do talk about the opioid crisis and the opioid crisis is what sparked this particular movement, that there is always going to be stuff that is that you can use for other talking about other drugs you can use for talking about alcohol, being in recovery is different from person to person, but you can be in recovery from a lot of different things or just one thing or whatever that looks like for you. And how does that translate to the workforce?
Rachael Cooper (24:19):
How do we make a recovery friendly workforce? It’s not just going to be recovery friendly for opioids, it’s going to be recovery friendly for everything. So really working on, you know, getting to that point where this understanding of substance use disorders as it pertains to any substance, not just opioids. And then lastly, really looking at what does it mean to be a recovery friendly workplace? How do we support people in recovery? What does that look like? And that is a question that it has a lot of different answers. There are certain organizations that have really focused on being a recovery friendly workplace. There’s different States that have really worked on it on a state level creating programs. And what that looks like is going to be critical, moving forward as more and more people move to recovery. Cause that’s the whole point is to get people to recovery.
Jon O’Brien (25:12):
I think KCA is much like probably a lot of the groups that you touched on. A lot of the associations you touch in that there seems to be some companies that are more active in areas, and some are more involved in raising the awareness on opioids and some don’t do as much, but the ones that seem to do a lot, they always come to me and they’re always like, well, what’s an example of someone that really does good in this area. And I want to turn to them and say, you know, you, but in your role, cause I always want to get better, you know, internally, but within your role, do you know good examples of companies that really go above and beyond and really lead by example?
Rachael Cooper (25:52):
Sure. Absolutely. So there’s a couple that come to mind and everything. Everybody does things a little bit differently. So for example, at KCA, you have focused a lot on this prevention component. The warn me labels, the education, the awareness, the stand downs, which is, you know that’s a classic prevention mechanism, education and awareness drives everything else. So, you know, when people are talking about prevention mechanisms, we talk about you, which is great. So that’s cool. When we talk about some of the policy stuff, we talk a lot about Nationwide, as an example, Nationwide has worked really hard to create a program for their for all of their campuses where there’s a lot of education components too, but they’ve also built a system that exists outside of their company’s intranet. So people can access it anonymously and get the support they need.
Rachael Cooper (26:48):
And then they do have a program that gets triggered when people either have a positive drug screen, or when they voluntarily go to a director, supervisor HR professional and say that they want to be enrolled. And it’s a treatment program. Well, it’s not a treatment program onsite, but it links them to a treatment program they’ve partnered with. And they work with doctors to find the best source of treatment. That’s the type of treatment that this person needs. And their success rate is very high for people who choose to enroll in the program. And then from a very frontline perspective, I’m fishing partnership support services in out of Boston is a really excellent example of working with the limitations of an industry, right? So fishermen often are out on the water for weeks at a time, meaning that they don’t have support if something goes wrong or, you know, if they are in an active addiction stage or if they have an opioid use disorder, then it can be really, really tricky.
Rachael Cooper (27:43):
So, JJ Bartlett and their crew have really worked to get in a lock zone on the boats to do peer report peer to peer recovery services to work with treatment providers in the local area, so that some of so that they work with them so that people can take their medications and all in a quantity that they can bring out on the water for several days so that they don’t have to miss doses, et cetera, et cetera. So those are some of the main ones we talk about, but I mean, there’s so, so many, and you know, one of the larger take home messages is that any action makes a difference. You might be an organization who doesn’t have a ton of capacity right now for whatever set of reasons, which is fine. It happens to all of us, you know, we all have to work on different things. There’s other, you know, there’s always urgent things and we all work to make sure that the urgent doesn’t crowd out the important, but we have to do both. So anything makes a difference. You know, we have videos in our opioids at work employer toolkit, there is a two and a half minute about drugs in the brain that you can show your employees, you know, during an all staff meeting, there’s five minutes, safety talks, the warning labels are free. Any one of those actions can make the difference in somebody’s life.
Jon O’Brien (28:56):
Yeah. I’m often approached by other contractor associations and they’ll say, Oh, you’re a leader in this area. And I’m like, well, I’m actually not, not a leader. I’m just a follower. National Safety Council is the leader.
Rachael Cooper (29:10):
You are a leader like in that, that’s the, one of those things that, you know, we all lead in different ways because leading by example is one of those really important things. And that’s one thing that we talk about a lot internally is we, you have to lead by example, things are important and you know, then you have to prioritize them. But if we don’t do it, then how can, you know, we all have to do it together.
Chris Martin (29:32):
That’s a great way to kind of pull this together. And Jon, I’m going to put words in your mouth and thank Rachael, but more importantly you know, isn’t it nice to hear from somebody that is overseeing the nation and how things are going, that you’re a leader. So hats off to you, Jon and the KCA for, for doing such a great job in Pennsylvania.
Thank you. We just want to keep doing our small little part and thank you for helping us.
Rachael Cooper (30:00):
Yeah. Oh yeah. Anytime. Yeah. That’s what we do. Yeah.
Chris Martin (30:04):
Well, Rachel, thank you for joining us today. And it was very, very important topic for the industry. Again, this is Chris Martin and my partner, Jon O’Brien we want to say thank you and we’ll have more exciting and very relevant topics coming up in future episodes. So stay tuned.