Construction and trades workers make up approximately one-third of people who die from opioid toxicity in Ontario, researchers have found.
A recent report by the Ontario Drug Policy Research Network (ODPRN) , a province-wide research collaboration based out of Unity Health Toronto, draws attention to the impact of opioid toxicities among people across various occupations over a recent six-year period - with the construction and trades sectors recording the highest rates of death among workers whose occupation was known.
Moreover, this group of workers also experienced an increasing rate of death over the study period.
"Our findings show that opioid-related deaths are not affecting all workers equally," says study co-author Tara Gomes , a scientist at Unity Health Toronto, professor at the University of Toronto's Leslie Dan Faculty of Pharmacy and principal investigator at the ODPRN. "Specifically, people working in industries such as construction, trades and mining experienced the highest rates of opioid-related deaths, with these deaths increasing considerably during the COVID-19 pandemic and remaining elevated over time.
"The reasons for this are likely multifaceted, including these occupations being male-dominated fields where people are at risk of injuries, undertreated pain, difficulty accessing treatment and barriers to discussing substance use."
The ODPRN research team used population-based health data from ICES, a not-for-profit research and analytics institute, to examine the trends and circumstances surrounding opioid toxicity deaths across employment sectors in Ontario from Jan. 1, 2018, to Dec. 31, 2024.
There were nearly 16,000 deaths in Ontario from opioid toxicity during this period and approximately 3,500 of these people had an occupation included in the coroner's report. The study showed that opioid toxicities had different effects across industries, with varying rates of toxicities, trends over time and circumstances of death.
"People across every walk of life and every kind of job are affected by opioid toxicity, though the circumstances behind those deaths and how we might prevent them are nuanced and often differ from one workplace to the next," says U of T PhD alumna Shaleesa Ledlie, a senior research associate with the ODPRN at Unity Health Toronto who was the study's lead author. "It's helpful for us to understand who is most affected and how, so we can tailor approaches and services to the specific needs of different people and workplaces."
The high rates of toxicities reported among workers in construction and trades was not surprising, says Andrzej Celinski, co-founder of the Reclaim Collective , an organization that, based on the lived experiences of its members, provides education and consulting services related to issues such as substance use, harm reduction and housing insecurity.
Celinski, a study co-author, has previously worked in the construction industry and is currently a board member for the Workers for Ethical Substance Use Policy .
He says that workplaces could take on a greater role in harm reduction.
"Drug use in the workplace, specifically construction and trades, doesn't get addressed very well. It's a workplace shaped by physically demanding work, injuries and chronic pain, and a culture where asking for help can feel risky.
"The workplace needs to feel safe enough for people to ask for support before things become too difficult to manage on their own and they feel they have nowhere else to turn. Making naloxone, overdose training or awareness, and connections to care more prominent in the workplace would help to reach people who might not access other traditional services, but this isn't happening in most cases."
A need for tailored programs and services that address underlying factors
Other occupational sectors were also significantly affected by opioid toxicities. People who worked in manufacturing, hospitality and retail each made up close to 10 per cent of deaths.
Rates of death among people who worked in civic and government services -including police, military personnel and firefighters - increased over the study period, while rates for manufacturing and transportation, warehousing and equipment operations were consistently high. The researchers note that these roles are often physically demanding, with high rates of workplace injury, chronic pain, mental health challenges and lack of support to manage transition from pain medications - all of which may increase risk.
Conversely, rates for other sectors - notably hospitality - peaked during the first years of the COVID-19 pandemic and have since decreased.
Approximately one-third of people who died were unemployed at the time of death, although the hospitality sector had a higher proportion of unemployment at time of death. The researchers say that this may reflect the impact of temporary layoffs. It may also suggest that loss of employment and transitions from the workforce because of injury, pain or mental health challenges may increase people's risk of substance-related harm.
"Taken together, these findings reinforce the need for programs and services that are tailored to the diverse needs of people at risk of opioid-related harm," says Gomes. "While workplace-based prevention, education and support remain important, with most opioid-related deaths occurring in people's homes, efforts must also extend beyond the workplace and include reducing stigma surrounding substance use and improving access to treatment and harm reduction services to better support people across the settings in which they live and work."
For example, structural factors such as housing instability, income insecurity and insufficient access to pain management and mental health care can all increase the risk of substance-related harm. As a result, an effective response would require many different harm reduction and treatment approaches to address underlying pain, trauma or mental challenges people experience.
"Toxicity deaths are not happening in a vacuum or to a specific group of people," says Celinski. "Not all overdoses are happening among folks who are unhoused or in public where people can see. Oftentimes, this is happening behind closed doors and in people's houses, often when they are alone, so it's invisible to the population.
"We need to look beyond individual behaviour and address the conditions that shape folks' ability to access support."
