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September 4, 2017

Construction industry stays vigilant against opioid abuse

HBJ Photo | Steve Laschever
HBJ Photo | Steve Laschever C.H. Nickerson is leading a $57 million wastewater plant project in Farmington.
HBJ Photo | Steve Laschever C.H. Nickerson Vice President Dan Radasci stands at a Farmington job site, where the construction firm can serve workers with random drug-testing notices.
HBJ Photo | Steve Laschever A board of name badges at C.H. Nickerson's Farmington job site. All of the positions shown are classified as “high-risk, safety-sensitive.”
Dr. Barry Sample, Quest Diagnostics

Working in construction is rough on the body, particularly as workers age.

That's one reason the industry is more susceptible to opioid use and/or abuse. Twenty percent of the spending from construction-related worker's compensation insurance claims filed in 2015 was for opioid prescriptions. That was double the percentage of other industries, according to property casualty insurer CNA, which said the manufacturing industry was also notable for its opioid spending.

Managers at Torrington-based general contractor C.H. Nickerson, which specializes in building wastewater plants, are well aware that physical labor can make a workforce more susceptible to opioid addiction.

“If you go out on a job site and witness what these guys do day in and day out, it's pretty rough on their bodies,” said Connie Tynan, C.H. Nickerson's director of human resources and compliance. “They're going to get these hurts and these strains and things, so their likelihood of becoming addicted is pretty high.”

That becomes a potentially dangerous problem when heavy machinery is involved.

“One person who's incapacitated and not functioning at their full abilities because they are impaired by drugs … could kill someone,” Tynan said.

That concern is why the company has been requiring pre-employment and random drug testing of its tradesmen and women since the 1990s. It's a choice. The company is not under any legal mandate to do so, said Tynan, who added that not all construction firms in the area require drug tests.

While Connecticut doesn't track the number of employers drug testing in a given year, data from Quest Diagnostics, which conducted 100,000 tests in the state last year, indicates an upward trend.

On any given work day, C.H. Nickerson employees, which currently number around 125, could arrive to the job site and be handed an envelope instructing them to report immediately to a nearby testing site for a urine screen.

If they fail the test, they are either let go or can participate in a treatment program, which could eventually lead to them returning to work.

The company can also order a drug test for an employee suspected of being under the influence. Managers received special training to recognize symptoms, which gives them probable cause under state law to test, Tynan said.

Connecticut law authorizes employers to conduct random urine tests on any employee deemed to be in a “high-risk, safety-sensitive” position. Many construction jobs fit that bill.

“We were probably one of the first contractors to do randomized testing,” said C.H Nickerson President Jon Miller.

That decision has cost the company a few employees over the years. Miller recalls some workers leaving when the policy was first instituted, simply because they disagreed with it. He didn't suspect they were using drugs.

For the company, which is always in search of skilled laborers, the downside of the rigorous testing policy is that an otherwise productive worker — perhaps one who smokes marijuana outside of work hours — could fail the pre-employment test or a random screen.

“Sometimes I think it's a limiting factor in getting labor, but it's just something you've got to deal with,” Miller said.

It's the price the company is willing to pay to weed out employees who use drugs on the job site.

While C.H. Nickerson has long tested its union workforce and own employees, several years ago it decided to pony up for a more comprehensive screen.

A standard urine drug test is known as a “five panel” test, and it typically detects heroin, cocaine, marijuana, amphetamine and phencyclidine (known as PCP, or “angel dust”).

But the test usually doesn't detect certain opioids, such as oxycodone and hydrocodone, which are addictive and can be abused. C.H. Nickerson's upgraded test can detect those opioids.

Overall, C.H. Nickerson has a low number of positive drug trusts possibly because the company has long been known for its testing, and it may discourage drug users from ever applying, Tynan said.

The decision to move to a more rigorous drug test was more about caution.

“We looked at it and said 'these things are not being checked,' ” Tynan said.

The increased cost per test is marginal — about $5 more. But the company orders many tests a year, and it does add up, Tynan said.

“It does get expensive, but in the long run it's worth it,” she said.

That's because the costs of dealing with workplace substance abuse can be significant. For example, for a 30-employee construction firm in Connecticut, it's estimated that substance abuse, on average, will cost that employer $13,495 a year, according a substance use employer cost calculator created by the National Safety Council. The calculator takes into account research on employment costs with data from the National Survey on Drug Use and Health.

The costs include: $5,440 for lost time or missed workdays; $4,385 for job turnover and re-training costs; and $3,670 for healthcare expenses.

C.H. Nickerson officials said they've been surprised several times over the years to find out that an employee flunked a test.

It's sometimes someone they never suspected.

“I think a lot of times, addicts have a stigma around them that they are less valuable than other members of society, but the reality is most of the addicts in our society are just like you and I,” Tynan said. “They just happen to be injured, or some circumstance in their life opened a door to them, and unfortunately their bodies took over.”

Tighter oversight

C.H. Nickerson isn't alone in its efforts to strengthen its drug-testing program.

In fact, drug-testing giant Quest Diagnostics has noted a steady increase in the percentage of tests that detect a greater number of substances.

In 2002, just 2.2 percent of Quest's urine tests on non-federal workers were more substantial than the standard five-panel test. That jumped to 5.6 percent in 2005 and 11.7 percent in 2010. Last year, 18.8 percent of the 6.6 million urine tests Quest performed in the country contained larger panels.

“We're clearly seeing more private-sector employers not subject to federal rules including this broader panel of opiates,” said Dr. Barry Sample, Quest's senior director of science and technology.

He attributes the trend generally to increasing concern and awareness of the opioid epidemic.

Making a dent

Users of prescription opioids, which can be expensive, sometimes turn to (cheaper and often more potent) heroin when they run out of money or lose their prescription or supplier.

Pills remain a concern, but data shows that government intervention — such as more rigorous prescribing guidelines, doctor-shopping safeguards and other policies — may be having an effect.

Quest's 2016 data shows a steep drop in the percentage of U.S. urine screens that came up positive for the prescription opioids hydrocodone, hydromorphone or oxycodone. In addition, tests that detected heroin plateaued last year after doubling between 2011 and 2015.

Sample said it's too early to tell if the heroin decline will become a trend.

“It's encouraging, but not too encouraging to breathe a sigh of relief,” he said

A June study by the Centers for Disease Control and Prevention, using data from 59,000 pharmacies, found that opioid prescriptions across the country declined 18 percent between 2010 (a peak year) and 2015, though the amount of the drugs prescribed per capita still remained three times higher than it was in 1999.

In Connecticut, nearly every county saw a drop in opioid prescriptions between 2010 and 2015, ranging from 2.7 percent in New London County to 24.7 percent in New Haven County. Hartford County saw a 15.1 percent drop. The exception was Middlesex County, which saw prescribed opioids per capita climb 3.3 percent.

However, five of eight counties in the state had higher prescription rates than the national average. And according to recently released data from the Agency for Healthcare Research and Quality, Connecticut had one of the highest rates of opioid-related emergency room visits in 2014.

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