While the nation as a whole addresses a surge in opioid addiction, the Portland-metro construction industry is not. Largely, industry professionals are less concerned about abuse of opioids than illegal drugs or alcohol.

“It’s not been a topic that we are focused on,” said Mike Salsgiver, executive director of Associated General Contractors’ Oregon-Columbia chapter. “We are focused on safety generally and the health and welfare of our members. Opioid use is of national interest, but it is not more of an issue for the construction industry than any other part of society.”

Phone messages were left with more than a dozen local construction companies in an effort to learn more about their approaches to the issue. Representatives of only two replied to discuss pain management policies or opioid use.

“It’s just not something that is a topic,” said Dan Mehls, vice president and general manager of Mortenson Construction‘s Portland office. “This is the first time I have been in a significant discussion about (opioid use). Companies don’t see it as their issue. It’s seen more as an individual issue.”

While the percentage of money spent on opioids by insurers of construction companies has remained relatively stable, it has been higher than the nation at large, according to a report by CNA Financial Corp. It studied nationwide claim analytics related to medical liability and workers’ compensation between 2009 and 2013. According to CNA Financial’s report from 2015, spending on prescription opioids accounted for 20 percent of medication claims by the construction industry. That was consistently 5 to 10 percent higher than the average spent by other industries recognized by CNA Financial.

In general, construction companies’ drug policies and drug tests cover both legal and illegal drugs. But separating legitimate medical use of painkillers, such as opioids, from abuse can be a challenge.

Another problem is that the construction industry generally isn’t eager to discuss pain and the use of drugs to alleviate it.

“Unless you fall into federal contractor status, there is not a lot that you must do when dealing with these issues,” said P.K. Runkles-Pearson, a partner in Miller Nash Graham & Dunn. “In that culture, there is an inability to admit there is an issue. It is easier to talk if it is out in the open, but those can be really challenging conversations.”

Contractors take the issue of addiction very seriously, according to Joe Hughes, owner of Joseph Hughes Construction.

“Of the people in the industry I know, if they have a drug abuse issue, they would be all over it,” he said. “A person under the influence – whether it’s a legal or illegal substance – it’s a danger to other employees and we can’t have that.”

For Hughes, alcohol and marijuana have presented bigger problems than has opioids.

“We have gotten several people into treatment for alcohol over the years,” he said. “As a company I am aware of addiction and been exposed to people with addiction. My default is to talk to them and get them treatment.”

For years, the industry has grappled with physical pain that can arise from job performance. Mortensen’s proactive approach has included institution of a bend-and-stretch program intended to help workers loosen muscles before beginning a shift. The program has helped, according to Mehls.

“What we do is try to prevent those kinds of muscle sprains,” he said. “There has been a reduction. It’s now mandatory, and we have been keeping track of injuries.”

Even with such programs, construction is a physical job. Workers who suffer injuries or pain often turn to prescription medications for at least a short-term solution.

“How you use what is a very powerful substance to deal with pain without getting them addicted is the issue,” Salsgiver said.

Increased information in the medical community on how to prescribe the medications is a key to preventing abuse. Lack of training is one of the biggest drivers for the use of prescription pain medications, according to retired anesthesiologist Sam Mertz.

“Doctors who aren’t trained in pain or who have no training in chronic pain will generally prescribe opioids,” said Mertz, a member of the Portland Club’s addiction research committee.

Another issue has become the widespread acceptance of prescription drug use to alleviate pain. Prior to the 1990s, prescription pain medications, especially opioids, were largely relegated to end-of-life treatment involving cancer patients.

A series of articles in medical journals in the mid-1990s that claimed that opioids were not addictive convinced many doctors of the drugs’ safety, Mertz said. Today, Americans use 90 percent of the world’s prescription opioids.

“It’s been a perfect storm,” said Mark Altenhofen, CEO of Oregon Pain Advisors. “There has been marketing by pharma companies, a lack of understanding of pain and a lack of understanding the dangers.”

One of the biggest dangers is that a patient who becomes dependent on opioids often will move on to substitutes like heroin. The drug is cheaper and readily available when a doctor’s prescription has run out of refills. In Oregon, deaths from heroin overdoses almost quadrupled from 3,040 in 2010 to nearly 13,000 in 2015, according to a report from the Centers for Disease Control and Prevention.

One bright spot in pain management is that attitudes toward prescription painkillers are starting to change. The Oregon Medical Board has become more stringent about the quantity of pills a doctor can prescribe.

“Doctors are saying, ‘You can have this many pills and if you are still in pain, we need to see you,’” said Elizabeth White, project manager for the Oregon Coalition for the Responsible Use of Medications. “If you are still in pain, something else is going on.”

Avoiding issues associated with painkillers starts with how they’re treated in the first place. A comprehensive approach that involves methods such as acupuncture, chiropractic and physical therapy often is the best approach.

“There is a place for biomedical,” Altenhofen said. “We need to incorporate other strategies like behavioral therapies, biofeedback and movement therapies.”

Most insurance providers have at least limited coverage for physical therapies and some are beginning to dive into treatments such as acupuncture and chiropractic.

Taking time to find the right combination of therapies for each individual patient is key to both treating workers and getting them back into the workforce without a dependency problem, according to Altenhofen.

“Slow and steady wins the race in getting people back into an active lifestyle,” he said. “Some of that is getting educated about what strategies are most effective and which aren’t. Otherwise we are just shooting in the dark.”

AGC isn’t recommending any changes or additions to policies regarding the use of painkillers, Salsgiver said. The construction industry is largely looking to see what state and federal officials do to address issues with how opioids are prescribed and used to treat pain.

“I think it is fair to say national attention on the subject shows it is a problem nationally,” Salsgiver said. “How construction fits into that is still to be determined.”

Most companies don’t see a reason to change or create policies for a problem that they don’t believe exists in the industry.

“If it is going on, it’s so well hidden, no one knows about it,” Hughes said.

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