Fewer California workers were dying on the job. Then fentanyl happened

As the nation continues to struggle with an opioid crisis now supercharged by fentanyl, overdoses have become one of the leading causes of workplace deaths.

California is no different: Workplace overdose deaths have risen so dramatically that in 2021 and 2022, they caused more fatalities than falls at construction sites or being hit by machinery, and in 2022 were second only to car crashes and other transportation incidents.

That year, the toll surpassed 110 workers, accounting for 18% of the state’s workplace deaths, compared to 11% nationwide.

Federal and state government experts have raised the alarm over this trend, which has puzzled some policymakers because drug use is not a hazard created directly by the job. After all, those who die of an overdose at work represent a small share of thousands of Californians who overdose each year.

Still, business owners and union officials alike are increasingly having to grapple with one of the nation’s most prominent public health challenges.

“When fentanyl came around, we started having a huge uptick in overdoses and deaths — even suicides,” said Paul Moreno, president of Ironworkers Local 433 in Southern California.

In 2022, his local began holding recovery meetings for members that now draw as many as a dozen attendees a month. Moreno, who said he’s been sober 19 years, visits worksites and the union hall passing around the 988 mental health crisis hotline number, giving out his own personal phone number and distributing doses of the overdose reversal drug naloxone (commonly sold as Narcan).

“I took Narcan classes, I passed out Narcan on the job sites. I never thought I’d be doing that,” he said. “The phone calls from the members, sometimes I don’t know what to say, besides listen. We still need more training.”

A new California law directs the state’s workplace safety agencies to require worksites to stock Narcan in their first aid kits, but the regulations haven’t been issued yet. A spokesperson said Cal/OSHA is “in the early stages of rulemaking,” a process that could take years.

Not much is publicly known about overdose deaths at California worksites. A small office in Cal/OSHA that compiles workplace fatality data has for at least the past two years noted the rise in overdoses in its annual reports. But the office says it cannot release details due to privacy restrictions.

The agency has not responded to a public records request CalMatters filed in September for all overdose incidents, fatal or nonfatal, that have been reported at worksites.

State won’t release details on deaths

County coroners’ offices, which investigate some deaths, vary widely in whether they can identify incidents based on whether a person died at their job. Death records from the past three years obtained from Alameda, San Bernardino and Riverside counties provide glimpses into the grim trend.

In 2021, a flooring installer stepped out for a smoke break at a construction site in Temecula, and was found by coworkers on the side of the house, dead from a fentanyl overdose. A packing plant worker in Corona went to the bathroom and did not return; coworkers found him bent over with a straw, lighter and piece of foil nearby, having overdosed on methamphetamine, fentanyl and heroin. In Fremont, a manager found a night-shift janitor in the bathroom with a white powdery substance, overdosed on fentanyl. In Livermore this year, a driver was found in his parked semi-truck as he waited to make a scheduled delivery, also dead from fentanyl.

California officials have little to say about the rising death toll. Cal/OSHA refused to make an official available for an interview and would not explain why overdoses account for a much higher share of the state’s workplace deaths compared to the rest of the nation.

Instead, the agency cited the broader national opioid crisis. “California had more than 7,000 people die from opioid-related overdose deaths in 2022,” spokesperson Erika Monterroza wrote in an email. “Unfortunately, these deaths happen all over our state, including in our workplaces.”

The state Department of Public Health says it is considering a study. That agency’s occupational health branch is “aware of this issue and is considering a project to examine all opioid overdoses by industry and occupation,” a spokesperson said. In October, the department said staff are in the “initial stages of preparing for an analysis” but did not provide a completion date.

Studies in other states indicate the problem is worse in certain industries. In Massachusetts, where overdoses are the top cause of workplace deaths, researchers with the state public health agency examined all overdoses deaths — whether at work or not — and found deaths occurred disproportionately among those working in manual-labor, high-injury industries.

Those jobs, said Emily Sparer-Fine, director of the Massachusetts public health agency’s Occupational Health Surveillance Program, are often seasonal or unstable, and workers may be financially strained and pressured to work through pain.

“Certain industries and occupations, (such as) construction, fishing, had a much higher rate of overdose,” Sparer-Fine said in an interview. “But it was also jobs that had lower access to paid sick leave, higher rates of job insecurity, higher rates of overall workplace injury.”

In a new study this year, Sparer-Fine’s team also dug into workers’ compensation data and found working-age Massachusetts residents were 35% more likely to have died of an overdose if they were previously injured on the job.

Workers in similar industries are overrepresented in the California workplace overdose deaths, including in trucking and warehousing, according to federal data.

So are workers in construction, where unions and employers are confronting a mental health and addiction crisis. Nationwide, construction workers are more likely than workers in any other profession to overdose, and also have one of the highest rates of suicide.

Chris Trahan Cain, executive director of the national Center for Construction Research and Training, has since 2018 led the response to the industry’s opioid crisis. She has focused on a longtime reliance on painkillers to deal with injuries involving the muscles and bones, which nearly a third of construction workers report experiencing. Studies like the ones in Massachusetts were among the first to reveal the toll.

The center, formed by the nation’s construction unions, has recommended stocking naloxone in union halls, requiring apprentices be taught about opioid abuse and ensuring members have coverage of drug treatment programs. They’re also providing tips on talking to doctors about how to treat injuries without long-term opioids prescriptions. The goal, Cain said, is to avoid blaming individual workers.

“When this information first came to light, what I heard was, ‘Oh, it’s just the macho culture, it’s the type of people who go into construction,’” she said. “We can’t tell you how many of these deaths are because somebody started on a prescription, but we know that some of them are. We know a lot of these deaths are also from illicit drug use that have nothing to do with workplaces, but where we can (make) changes as an industry to impact these numbers, is what we’re trying to do.”

Businesses respond to crisis

Employers, too, are trying to break the stigma for seeking help. Since 2021, the Associated General Contractors of California has provided materials to hold jobsite meetings about mental health.

Not all employers know how to raise the issue and some fear reprisal for appearing to pry into employees’ personal lives, said Frank Nunes, CEO of the Wall and Ceiling Alliance, a Northern California specialty contractors’ group. Some, Nunes said, are advised by attorneys to avoid talking about it.

“It’s still very sensitive,” he said. “You’ve got to be very careful how you ask somebody how (they’re) doing and not offend them.”

Still, Nunes joined officials of District Council 16 of the International Union of Painters and Allied Trades at a recovery event in San Leandro in October, promoting treatment programs covered by their contracts and encouraging workers to use them.

“We have to address these things in the field,” he told about 100 union members. “There’s a cultural change we all need to work on.”

In a cavernous training hall where apprentices learn how to install drywall, union members told their peers how they had recovered from addiction. The union invited former Raiders tight end Darren Waller to talk about his own experiences with addiction and depression.

Reflecting on union officials’ numbers on construction worker deaths by overdose or suicide, Waller told the crowd: “Those are lives that still deserve to be among us.”

Robert Williams, the local’s business manager and secretary-treasurer, described what he called a familiar scenario: A worker experiences a jobsite injury or persistent soreness, feels pressure to work through it, then escalates from an over-the-counter pill to a prescription painkiller to an illicit opioid addiction.

“We’re only with our families a small portion of the day,” he said. “The people we work with, we’re with 80% of the time. We’ve got to be open on those job sites.”

The union and local employers realized they had a problem on their hands last summer. After sifting through their health plan records, they found 91 members had died of overdose or suicide (not necessarily at work) in 18 months.

The revelation forced union officials to rethink their roles in workers’ lives, Williams said in an interview.

“We look out for safety on the jobs, so if there’s a death on a job site because of a safety hazard, it’s front-page news,” he said. “But if there’s death by an overdose or death by suicide of a construction worker when they go home, nobody talks about that. So instead of thinking about just the safety side, it’s that holistic side of, how do we make somebody better for themselves and their families?”

Williams quickly appointed a director of addiction and mental health. James Boster, himself in recovery from a painkiller addiction he said he developed after a non-work injury, speaks at apprenticeship programs and worksites, helps workers get into recovery programs and acts as a crisis counselor.

In the past year, Boster said he’s helped place 51 union members into residential or outpatient treatment programs. During a recent interview at the union’s headquarters in Livermore, he said he was anxious: He had secured a “scholarship” for one member who hadn’t logged enough hours in recent months to have full health coverage, but the worker had chosen to postpone treatment.

“I can never walk away from a member, and something happens, and not hold that personally,” Boster said.

Boster and Williams are eager to expand their program. Ideas include installing someone with Boster’s role across the district’s 20 local unions and establishing a fund to help members who haven’t worked enough hours to afford treatment.

Other advocates, meanwhile, have pushed the state to require naloxone at worksites as part of an overall strategy to reduce overdoses.

Earlier this year, the National Safety Council, an advocacy group, petitioned California labor agencies to do just that. Proponents said the medication, which can temporarily reverse an overdose by blocking the brain’s opioid receptors, is easy to administer and not harmful.

Citing its workplace death data, Cal/OSHA supported the proposal before the independent Occupational Safety & Health Standards Board, which decides whether to approve such regulations.

“It’s in the top two or three killers of workers now, and just a few years ago, it was a very small number,”  Eric Berg, Cal/OSHA deputy chief of health and research and standards, said at a June 20 board meeting. “So it’s just become a really serious problem for workers, and it’s killing workers. I think we have an obligation to act.”

But board members hesitated. Chairperson David Alioto called the proposal an “odd request.” While addiction is a legitimate public health concern, it’s not a workplace hazard like wildfire smoke for employees who must work outside, he said.

“I have not seen a regulation where an employer is providing a remedy for a risk that the employer did not create,” Alioto said.

Board members also said they worried about whether all businesses would be able to store the medication at the right temperature, and whether employers would bear liability over the medication’s use.

The standards board ultimately voted for the agency to discuss the matter before an advisory committee. In September, Gov. Gavin Newsom signed a law directing Cal/OSHA to draft a workplace naloxone rule by December 2027 and giving the board until December 2028 to consider it. So far, no advisory committee has met.

Share your story: We want to hear from workers, family members and employers. If you have experience with addiction, mental health or overdose on a job site, and you’re willing to share your story with a CalMatters reporter, please reach out to jeanne@calmatters.org.

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