Chronic Pain, Painkillers, and the Opioid Risk in Construction

Why this matters

The trades do not have an opioid problem because tradespeople are reckless. They have one because the work injures people, the injured keep working, and the most available tool for working through pain for most of the last two decades was a prescription. A shop owner rarely sees the start of it. He sees the end: a strong tech who has started missing Mondays, a near miss in the van, a death that the crew did not see coming and the owner thinks he should have. Most of the path between the injury and that end runs through decisions the shop makes about light duty, sick time and what it is allowed to say out loud.

What the data shows, and what it does not

Two sources carry most of the weight.

• CDC's 2020 analysis of overdose deaths by occupation, covering 2007 to 2012 death records from 21 states, found construction and extraction occupations had the highest rate of both drug overdose deaths and opioid-involved overdose deaths of any occupational group studied.
• The Massachusetts Department of Public Health's 2018 report on opioid deaths by occupation, covering 2011 to 2015, found construction and extraction workers died of opioid-related overdoses at about six times the average rate for all Massachusetts workers.

Read them carefully. These are death-certificate studies: they show where deaths concentrate, not why, and the state report is one state's population. They also predate the shift of overdose deaths toward illicit fentanyl, which changed the risk profile. What has not changed is the industry ranking: the trades sit at or near the top of every occupational breakdown that has been published. Check CDC's and NIOSH's current occupational overdose pages for newer data; this card is current as of 2026.

The industries at the top share three features: high injury rates, physically demanding work that is hard to do while hurt, and low access to paid sick leave or light duty. The third one is the shop's.

How a work injury becomes a dependence

The vocabulary matters, because using the wrong word in the conversation ends it.

• Tolerance: the same dose does less over time, so more is needed for the same relief. Expected with regular opioid use.
• Physical dependence: the body has adapted, so stopping causes withdrawal (aching, sweating, nausea, insomnia, anxiety). Also expected with regular use, and not the same as addiction.
• Opioid use disorder: the medical term for addiction. Continued use despite harm, loss of control over amount, craving, and life organized around getting the drug. A diagnosis, made by a clinician.

The path that turns a strain into the third one usually looks like this: an injury, a short prescription, a return to full duty before the tissue has healed, pain that the work keeps re-aggravating, refills to keep working, tolerance, a doctor who eventually tapers or stops the prescription, and then withdrawal on a Monday morning with a full schedule. That last point is where people turn to pills from a friend or the street, and the street supply in 2026 is dominated by fentanyl, including counterfeit pills pressed to look like prescription tablets. That is why the end of this path is so often a death rather than a slow decline.

Notice how many links in that chain are work: the injury, the return before healing, the re-aggravation, the full schedule that cannot be met in withdrawal.

Where the shop's decisions sit on that path

• No light duty. A tech who must choose between full duty and no paycheck chooses full duty, and full duty on an unhealed back needs something to make it bearable. See related: Returning to Work After an Injury: The Modified Duty Plan.
• No paid sick time. Missing a day costs a day's pay, so a flare gets medicated instead of rested. Several states and cities now require paid sick leave (California, New York, Washington and others, with differing accrual rules); no federal law requires it for private employers.
• A culture that punishes mentioning pain. If "my shoulder's acting up" earns a joke or a doubt about commitment, the tech stops saying it and starts managing it alone. See related: The Language That Keeps People Quiet About Pain.
• Treating any prescription as a disciplinary event. If a tech believes that telling the shop about a lawful prescription will cost him his route, he will not tell you, and you lose the chance to keep an impaired driver out of a van.

Clinical practice has moved too. The CDC's 2022 Clinical Practice Guideline for Prescribing Opioids for Pain advises nonopioid treatment as the preferred approach for subacute and chronic pain, and, for acute pain, prescribing no more than the expected duration of severe pain. A tech's doctor is more likely now to offer physical therapy and non-opioid medication first, and the shop's job is to make it possible for him to follow that advice, which usually means giving him work that does not re-injure him while he does.

Worked example: the same injury, two shops

Illustrative. Two garage door techs, both 44, both strain a shoulder lifting a section on the same kind of job. Both see a doctor the same day and get the same advice: a short course of medication for the first few days, physical therapy twice a week for six weeks, no overhead work or lifting over 20 pounds for four weeks.

Shop A has no light duty. Its owner says, honestly, that a door tech who cannot lift is not a door tech. The tech takes three days off without pay, comes back at full duty on day 4 because he cannot afford a fourth, and skips physical therapy because the sessions are during working hours. The shoulder re-aggravates on every spring change. He asks for a refill in week 2 and again in week 4. In week 7 the doctor declines a third refill and refers him to a pain clinic with a six-week wait. By week 9 he is missing Mondays and has twice been late on first calls.

Shop B uses a written modified duty plan. The tech does estimates, opener programming, diagnostic calls and ride-alongs where a second tech does the lifting. Physical therapy appointments are scheduled into his day. He takes the medication for the first three days only, because by day 4 he is not lifting. He is back to full duty in week 5 with a one-week taper.

Count the difference in the units it actually comes in. Shop B's tech spent about four weeks producing less than a full day's billed work. Shop A's tech lost three unpaid days in week 1, produced full days from then through week 6, then a falling fraction of them, and by week 9 he is a tech whose next missed Monday or next near miss in the van is a matter of when. The weeks of lower output in Shop B are not a cost Shop A avoided; Shop A deferred them, with interest, into a problem it is now not equipped to handle.

What would flip it. If the injury had been off the job, or the tech had declined modified duty, Shop B's plan would not have happened, and the tech would have been back on Shop A's path through no fault of the shop's. The lever then is the conversation, not the schedule.

What to say, and what not to

The conversation is about function and safety, not about drugs. You are the employer, not his doctor.

Say: what you have seen ("You've missed three of the last five Mondays, and you nearly backed into the Morales mailbox"), what you need ("I need to know you're safe to drive the truck"), and what you can offer ("We can put you on diagnostic calls for a few weeks while your shoulder heals, and the EAP is confidential if anything else is going on").

Ask: "Are you on anything that affects your driving or your reaction time?" A lawful prescription with a drowsiness warning is a driving question, and the answer changes the assignment, not his employment.

Do not: guess at a diagnosis out loud, ask what pills he takes, search his van, or promise confidentiality you cannot keep if there is an immediate safety issue.

Where impairment is happening on the job right now, the safety line applies today: he does not drive, he does not work at height, and the shop's substance policy governs what follows. See related: Substance Use and the Safety Line: A Decision Tree. For confidential counseling and referral, see related: What an Employee Assistance Program Is and How a Small Shop Gets One.

Naloxone, and what to do in an overdose

Naloxone reverses an opioid overdose. The nasal spray has been available over the counter since the FDA approved nonprescription sale in 2023, and NIOSH has published guidance for employers on keeping it on site. Putting it in the shop's first aid kits, and in trucks, costs little and signals that the shop would rather have a living employee than a clean image.

The signs of an overdose: unresponsive or barely rousable, slow or stopped breathing, blue or gray lips and fingertips, pinpoint pupils, gurgling or snoring sounds.

The response: call 911 first, or have someone else call while you act. Give the naloxone spray into one nostril per its label. If breathing is absent or very slow and you are trained, start rescue breathing. Stay with the person, because naloxone can wear off before the opioid does, especially with fentanyl, and a second dose may be needed after two to three minutes if there is no response. Roll a breathing person onto their side. Most states have Good Samaritan laws limiting liability for someone who gives naloxone or calls for help in an overdose, though their scope varies.

The legal layer

At the federal level, the ADA (employers with 15 or more employees) does not protect current illegal drug use, but it does protect a worker in recovery and a worker lawfully taking prescribed medication, including medication for opioid use disorder, unless the medication makes them unable to do the job safely. The EEOC published technical assistance on exactly this in 2020. Drivers holding a commercial license and operating vehicles under DOT rules are covered by DOT drug testing, which includes the common prescription opioids, and a different set of rules applies to them. State law on medical marijuana and off-duty use varies too widely to summarize. Before any discipline or termination involving a medication or a substance, talk to an employment attorney. This is not legal advice.

References

• CDC, MMWR, occupational patterns in drug overdose and opioid-involved deaths, 2007 to 2012 (published 2020)
• Massachusetts Department of Public Health, opioid-related overdose deaths by industry and occupation, 2011 to 2015 (2018)
• CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022
• NIOSH, Using Naloxone to Reverse Opioid Overdose in the Workplace; U.S. EEOC, Use of Codeine, Oxycodone and Other Opioids: Information for Employees (2020)
• See related: Substance Use and the Safety Line: A Decision Tree