Hard Hats, Hidden Harm: Chronic Pain, Subtance Use & Mental Health in Construction

Imagine a seasoned construction worker — let's call him Chris — suffers a back injury while on the job. Initially, the pain was manageable, but over time it became intense and persistent. Seeking relief, he turned to prescription opioids. What started as a temporary solution soon spiraled into dependency. His work performance declined, relationships became strained — and Chris finds himself trapped in a cycle of pain, medication and emotional struggle.

Chris’s experience is not unique: It reflects a broader crisis affecting the construction industry, where injuries, chronic pain and substance use often intersect in ways that threaten both workers’ health and workplace safety.

By integrating wellness and mental health into daily operations, providing practical support and promoting transparency and trust, construction companies can protect their most valuable asset: their people. Moving beyond the hard hat, leaders have the opportunity — and responsibility— to confront hidden harm and create a safer, healthier and more resilient industry.

The Alarming Statistics

The numbers are sobering. Construction and extraction workers have the highest drug overdose death rates of any occupational group, with 162.6 deaths per 100,000 workers, more than four times the national average for all occupations.

Workers in this sector are overrepresented in opioid-related fatalities, with construction accounting for roughly 17% of overdose deaths despite making up only about 8% of the workforce. Synthetic opioids, including fentanyl, have driven recent spikes in fatalities, underscoring the urgent need for workplace interventions.

Beyond the immediate risk of overdose, untreated or poorly managed pain contributes to lost productivity, higher turnover and increased workplace accidents, making this a safety and operational concern as well as a public health issue.

Several factors make construction workers particularly susceptible to opioid-related harm. The work is physically demanding, often involving heavy lifting, repetitive motion and high-risk tasks. Injuries are common — and chronic pain can often follow, which is frequently treated with prescription opioids.

Many workers lack paid sick leave, so they may delay treatment or return to work before fully recovering, increasing the risk of further injury and dependency. Seasonal and transient employment creates additional stress, while the pressure to meet deadlines can push workers to self-medicate rather than seek help.

Cultural norms also play a role. Construction has long promoted a “tough guy” mentality, where admitting pain or mental health struggles is discouraged. Workers who reach out for help risk judgment or perceived weakness. This combination of physical, economic and cultural pressures creates a perfect storm for opioid misuse and mental health challenges.

Interventions That Work

Addressing these challenges requires multi-faceted strategies. On-site naloxone training equips workers to respond immediately to opioid overdoses, potentially saving lives. Safer pain management protocols prioritize non-opioid treatments, set prescription limits and encourage ongoing monitoring.

Return-to-work programs help injured employees reintegrate gradually, balancing recovery with productivity. Employee Assistance Programs (EAPs) offer confidential counseling, resources and extra support, while peer networks provide trusted avenues for workers to discuss struggles without fear of stigma or reprisal.

Private outreach is particularly effective. Establishing these supports within the jobsite routine — rather than as an afterthought — can prevent small issues from turning into crises.

The Center for Construction Research and Training (CPWR) has been at the forefront of addressing opioid misuse in the industry.

Their “Opioid-Related Harms Prevention” initiative integrates toolbox talks, training sessions and hazard alerts into daily jobsite routines. One pilot program, in partnership with North America’s Building Trades Unions (NABTU), trained peer advocates to provide confidential support to coworkers struggling with substance use or mental health issues. Early results indicate that peer-led programs reduce stigma, encourage resource use and help teams maintain both safety and productivity.

These programs demonstrate that structured, culturally aware interventions can work. They combine education, peer advocacy and access to professional resources in ways that respect the unique pressures of construction work.

Leading the Way

Industry leaders play a key role in creating real change. Safety meetings can evolve to include discussions on pain management and mental health alongside traditional safety topics. Making sure workers know about and can access EAPs or other support services strengthens the safety net.

Leaders who model openness and encourage honest conversations help reduce stigma and build trust. Collaborating with healthcare providers ensures injured workers receive effective treatment without unnecessary reliance on opioids.

The intersection of chronic pain, opioid use and mental health challenges represents a hidden but profound threat to the construction workforce. Addressing this issue requires both cultural and procedural changes.

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