Episode 4: Reduce Musculoskeletal Injury, Reduce Opioid Addiction | Cal Byers shares injury prevention strategies

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Listen to the audio-only version of this podcast on our Suicide Prevention page, and take a moment to sign the Suicide in Construction Awareness Proclamation while you’re there.

Sandy: Welcome to the AsphaltPro Magazine podcast miniseries for mental health wellness and suicide prevention. I’m magazine editor Sandy Lender and your host for this mini series. In this three-part podcast, we’ll explore ideas for incorporating a mental health wellness component into your safety program. 

Sandy: AsphaltPro is honored to expand the conversation around this important topic and to bring Holmes Murphy’s Cal Byers to the podcast for that purpose. Cal Byers has over 30 years of safety risk management and insurance experience. He has expertise in a host of emotional intelligence programs such as mental health, suicide prevention, employee well-being, safety culture development, transformation, wellness program design, implementation, and evaluation, as well as employee assistance programs and more. He is the vice president of workforce risk and worker wellbeing at Holmes Murphy and Associates. 

Sandy: Let’s begin part one of this three-part podcast getting a feel for the opioid crisis exacerbating mental health suffering in the construction industry. Cal, could you start us off with some stats about how many of our construction workers or what percentage of our construction workers are being prescribed opioids and why should that number concern us?

Cal: This is really frustrating. Public health data can be really hard to come across. At this point, there is no national database that shows the frequency or the severity of the opioid crisis impacting construction. I’m aware of three jurisdictions that have data. So it’s very similar to what we had with suicide in construction. We suspected for years before the data [was available] in July of 2016, that construction would have a high-risk population. The same is true with opioids. The three jurisdictions where data exists, construction is in the top three. So that’s been the state of Massachusetts, Toronto in Canada, and King County in Washington state, where Seattle is based. Okay, so the data shows construction does have a high risk for opioid prescriptions. Nationally, the number of prescriptions for opioids, both for primary care and for emergency room visits, continues to decline. Pharmacists and data scientists would tell you there still are examples of overprescribing, but there are other gateways to new persistent opioid use that people need to be aware of. So that includes prescriptions for on and off-the-job injuries and surgery, and then diversion of the almost three billion pills left over every year. So diversion is [when] 90% of people don’t discard leftover opioids, and then people in our homes—pre-teens, teenagers, young adults, and other guests in our homes—divert those pills and use them for personal use or to share with others. Those are three leading gateways. The data will show for construction workers, 55% of the time for musculoskeletal injuries, construction workers were receiving prescriptions. And when we received prescriptions, they were 20% stronger doses and 20% stronger or longer duration.

Sandy: Okay, right. And that duration is something I wanted to ask about. I’ve seen stats from CPWR that show the likelihood of becoming dependent on an opioid spikes at around day five of a prescription. Have you seen similar data to that? Is that something we should be watching out for when a worker has been prescribed something? How do we help educate employees and their families?

Cal: Okay, letting them know that non-opioid pain medication exists and that its efficacy is very strong. In fact, there’s data that will show the efficacy for multimodal pain relief is three times stronger than opioids, especially when it comes to surgery. So non-opioids pain medication does exist. And then secondly, the data from various sources will show day five is the magic point to have someone off opioids. However, you could have a person with a predisposition to an opioid addiction where a one-day dose could be enough to change the dopamine cycle in their brain. I’m not an expert on that. That’s a clinical topic. But as a risk management and safety professional, I’ve learned enough to be able to educate people. So the data will show if the initial episode of opioids is eight days or longer, [that results in] a 13.5% likelihood of persistent opioid use. If that initial episode of use exceeds 31 days, [there’s] a 29.5% chance of persistent opioid. So digging through the data, the scientists and the pharmacists would say day five because if your initial episode was a single day, you would have a 6% likelihood. Okay. So the goal is to [use] opioids sparingly or find opioid alternatives for pain management. 

Sandy: And then, you know, you mentioned education. But other than education, I mean, how do we implement programs that can prevent injury? I mean, obviously, people are being prescribed these opioids or even a non-opioid because they’re in pain, they’ve had an injury. How do we implement some programs to prevent injuries in the first place?

Cal: First and foremost, I’m a safety and risk management professional. When people tell me what’s the most effective first dose prevention strategy for opioids, it’s reducing the frequency and severity of musculoskeletal injuries. The CPWR says 34% of construction workers have at least a single musculoskeletal injury. And repetition of musculoskeletal injuries might be known as a repetitive stress disorder or a musculoskeletal disorder, MSD. So there’s both. If we can eliminate those, and there’s many ways that you could do that, it would be imposing weight restrictions, it would be two-person lifts, it would be job rotation, it would be material handling equipment. In the construction industry, we don’t like the word ergonomics, but that’s the basis of human factors engineering. And so the more we can adapt the load to the worker rather than the worker to the load, the better off we’ll be at preventing those injuries. And the more you have those musculoskeletal injuries, the higher the likelihood of having repeated and longer durations of those opioid pain medications.

Sandy: One of the questions I want to ask you, along the lines of those injuries, is, are we bringing workers back to work too soon after injuries? I know that’s kind of broad. Every worker is different. But in our construction industry right now, we have a dearth of workers in the workforce—are we trying to get workers back too quickly?

Cal: In many ways, workers already have that inclination. If they’re not at work, there’s concern about not being paid or there’s concern about impacting the contractor’s workers comp, or they’re worried about having their crew run short, creating overtime, increasing costs, imposing a burden on co-workers. So that is the factor. The challenge has been what is the best and most effective way to return people to the workplace? So you can have return-to-work programs. It’s better to have employees stay involved in work, being able to do what they’re able to do. So that challenge is re-aggravating an existing injury, which could compound a worker’s compensation claim. The challenge is, I’m old enough to remember when people were sent home and they were recuperating on their couch. It was at that point called the soap and suds phenomenon. And the soap was watching soap operas on TV, and the suds were drinking a beer. Then, more proactive companies began to aggressively manage their injuries and especially the recovery of return-to-work duration. 

Cal: If you can find modified duties that keep the worker engaged, the contractor gets to continue building that relationship, demonstrate care, have empathy for that person, and the person knows that people care about them. Getting employees to stay within the restrictions is sometimes hard, so it puts a burden on the foreman, the superintendent, and project managers to really manage those limitations and restrictions. Many doctors will allow workers to work with restrictions, but if the employee says I’m getting pressured or I’m doing more than I’m supposed to be doing, frequently that will curtail that modified duty. But it’s ideal to maintain contact with that injured employee and the better you’re able to spend time, [the better] you’re able to see what their capabilities and restrictions are. But make this a win-win and have the employee recover doing what they’re able to do. And a lot of times, those modified duties will be alternate productive work. I’m not a big believer in having people put caps on screws sitting in an office. Put them to use doing something productive so the employee knows this is a contribution or it creates resentment by other workers, it creates pressure to get that employee back to work. The goal needs to be “Let’s focus on your healing, we’re taking care of you, we believe in proper workplace safety.” So claim management is a really important part of this as well.

Sandy: Now, I don’t know how to ask this question, but you’re bringing up a thought of in the smaller company where a worker who’s integral to the paving crew has gone out on a workers’ comp issue. I would imagine it’s more difficult to bring that worker back in on modified duty, having him do something that’s not integral to the paving team when the contractor needs everyone on board. And I would think that the pressure would be on the worker who’s been injured. It would be on the contractor. It would be on everyone on that team. How do we work with that safety culture? How do we work with that safety director, if they even have a safety director in such a small company? How do we work with these folks to help the contractor and to help that worker so that he’s not feeling that pressure? 

Cal: For many years, I’ve partnered with small and medium-sized enterprises, not just worked with large. That is one of the big challenges. So having that contractor really do a strong orientation with new hires, there’s very pronounced data that the frequency of injuries for new hires within their first 30, 60, 90 days, and even the first year of employment is going to run high. So, for small and medium contractors to recognize what your historic leading types of loss have been and then build in job and task-specific training so you can focus on preventing those soft tissue injuries. That’s to me where the magic lies. But it’s hard because these companies not only might not have a safety director, they’re not likely to have a full-time HR director. And you just have fewer people managing the safety and the workers’ compensation claim. But I would encourage people to tap the resources from your broker, tap the resources from your insurance carrier. View them as friends and allies. Ask for their support, ask for their help. See if you can get support in providing training. I’m finding more employees are open to the safety message today than at any time in the past. People are recognizing they want to have their whole body when they retire to be in better shape.

Sandy: It’s been a pleasure talking with Cal today. I hope everyone listening in has picked up something they can use in their companies to expand the conversation around mental health wellness and reducing opioid use in their workforce. I want to encourage you to follow Cal on LinkedIn. You can find the Holmes Murphy and Associates Insurance Brokerage online at www.holmesmurphy.com. If you or a colleague needs immediate help, the Suicide and Crisis Lifeline has licensed counselors standing by at all times to speak with you. Please call or text 988. Thank you for tuning in and thank you for your willingness to share this podcast and conversation with others.