Naloxone kits to deal with opioid overdoses must become a staple health and safety tool at all construction sites alongside steel-toed boots and construction hard hats, harm-reduction workers told a Hamilton, Ont. Construction Safety Week audience recently.

Hamilton-Halton Construction Association (HHCA) general manager Sue Ramsay explained to members that on March 1 the Ontario legislature passed the Working for Workers Act, implementing a new mandate for the construction sector to “reduce the risk of death caused by opioid overdoses in workplaces by requiring employers to provide a naloxone kit in workplaces where overdoses are a potential hazard.”

That clearly targets construction employers, Ramsay said.

“Mental health and substance abuse are real concerns in our industry. As employers, we have to do everything that we can to support and protect our workers,” she remarked, referring to the legislation.

“Obviously, these are really complex issues, best explained by experts.”

Ramsay recruited two regional harm-reduction workers from The Aids Network, Tess Hopkins and Marijo Watt, to offer context and practical advice to HHCA members as part of the May 5 session billed as Naloxone and Harm Reduction 101. Each table had two small pouches, one with needles, syringes and vials of naloxone and one with a nasal application.

The case for harm reduction with naxolone kits in the construction sector is strong, Hopkins stated, noting research by the Ontario Drug Policy Research Network from 2020 indicates 30 per cent of opioid-related deaths among people employed during the pandemic occurred among those working in the construction industry.

The Other Pandemic Campaign, launched by the Ontario Construction Consortium in partnership with Ontario Harm Reduction Network in 2021, urged unions and contractors to increase training and education on opioids.

“You have the Ontario Construction Consortium talking about safe supply. That’s not something I thought was in the realm of possibility two years ago, three years ago,” said Hopkins.

It has become a “perfect storm” in the past two years, the HHCA audience was told – a flood of “poisonous,” impure opioids hitting the streets during the pandemic, construction workers continuing to be over-represented among opioid users, and now with worker shortages there is greater pressure than ever for workers to find a way to work through chronic pain.

“Everywhere you go, there’s a critical shortage of workers and pressure to get back to work,” Watt said. “One in three construction workers across the country, union or non-union, reported problematic substance use. This doesn’t discern between alcohol or drugs. But that number is alarming. You can stop people from dying just by having naloxone available.”

Examples of opioids are heroin, fentanyl, oxycodone, hydrocodone, codeine and morphine, Hopkins explained. Fentanyl is 100 times stronger than morphine and it is often mixed with other opioids, fentanyl analogues or different types of depressants.

Carfentanil is a fentanyl derivative and 10,000 times stronger than morphine.

Law enforcement, including major drug seizures, forces street sellers to mix products based on availability, with benzodiazepines, a category of depressant, often part of the mix these days, Hopkins explained.

“People have no idea what they’re putting into their bodies,” she said. “People that use substances are dying accidental deaths, they’re being poisoned to death by a toxic, unpredictable drug supply.”

Watt added, “It is nearly impossible to get pure drugs anymore. Especially we’re seeing throughout COVID with the closure of the borders, people are unaware of what their drugs contain.

“So we are trying to get naloxone in the hands of everyone. Because if you don’t have it, you risk overdosing if you use drugs.”

Naloxone is a drug that reverses an opioid overdose. It restores normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose, taking about two to five minutes to work and lasting between 30 to 90 minutes in the bloodstream.

If naloxone is administered on someone who does not have opioids in their system, it has no effect and causes no harm.

Ramsay noted while the legislation has been passed, the specific regulation mandating naloxone kits in the construction sector has not been proclaimed, with regulators said to be giving the industry time to adapt.

Meanwhile, Hopkins said, firms should train staff on recognizing when the kits should be used as part of an inclusive and supportive work environment.

And right now, she said, employers should be getting their hands on naloxone kits – start by looking up the Ontario Harm Reduction Distribution Program Locator, contacting local mobile harm-reduction services, or inquiring at pharmacies. Kits are free.