Canadian Biomass • Spring 2024 • Confronting the opioid crisis

Opioid-related poisonings are plaguing many parts of Canadian society, and workplaces aren’t immune from the issue. Data put together by the Institute for Work and Health shows that workers in the forestry, fishing, and trapping sector are at high risk.

Only construction workers are experiencing a higher rate of opioid poisonings, according to the data. And forestry workers who are in the 45 to 65 age range account for 60.3 per cent of all overdoses in the sector, it said.

With that in mind, Talent Canada and OHS Canada — sister media brands to Canadian Biomass — recently held an in-depth discussion on what to do if a worker overdoes on the job and how leaders can support their recovery long term.

Candace Plattor, an addictions therapist with Love With Boundaries, shared the story of “Dave” — one of her clients — as an example of how an opioid addiction can progress.

Dave was in his 30s and was a site supervisor at a construction site in British Columbia.

“He didn’t hurt himself on the job, he hurt himself playing football with friends,” she said. With a bad knee injury, he tried to continue working — but it became almost impossible because of the level of pain.

He went to the doctor, who prescribed him opioids to ease the discomfort, she said. The doctor also gave him a leave of absence to recover. At first, things were fine — he moved back home with his parents to save money while he focused on his recovery.

“But opioids are addictive, and his body became addicted to them,” she said. “Even though he really wasn’t in increased pain, he went to his doctor and said, ‘My pain is worse and I need more drugs. I need a higher dosage.’”

The doctor gave him additional medication, but soon scaled it back, she said. He wasn’t cut off completely, but he wanted more than what he was being given, she said.

“Dave went to the downtown eastside of Vancouver and he started buying the pills on Main and Hastings, but it got to be too expensive for him,” she said. “So, he went to heroin. He was even seeking out fentanyl because it could give him the hit that he wanted.”

His entire personality changed, he had volatile mood swings, and he even became violent at times, said Plattor. And that all stemmed from a simple injury to his knee while playing a game of football with his friends.

Vicky Waldron, executive-director of the Construction Industry Rehabilitation Plan, is a fan of the acronym SAVE ME. It lays out, in a handy format, the steps that need to be taken in the case of a suspected opioid poisoning.

SAVE ME is “stimulate, airway, ventilate, evaluate, muscular injection, evaluate (whether a second dose is required).”

“The first thing you do is call 911, and then you begin the steps,” she said. That includes a sternum rub, to see if the person is awake.

“You don’t want to go straight in with the injection because naloxone puts people into what we call precipitated withdrawal,” said Waldron. “It’s a temporary reversal of the overdose, and it puts them into withdrawal right away. It’s a harsh, fast, and quick withdrawal.”

The risk is that people might get up and run away and try to overdose again, she said, because the withdrawal symptoms are immediate and painful.

“When that happens, they may go off and use again — but they won’t get the effects of the opioids because they’ve got naloxone in their system,” she said.

Naloxone has a half-life of about 90 minutes, while opioids have half lives ranging from four to eight hours.

“What that means is that, once the naloxone has disappeared, the opioids that were in the system are going to reattach to the receptor sites,” she said. Add in the new opioids the person ingested, and there is an increased risk of a fatality.

“In reversing an overdose, you do want to call 911 first because then you can say to them that we’ve administered naloxone, they know they’ve got to get there fast, and then they can get into a safe environment as they watch for the reversals,” said Waldron.

Mike Russo, president of WorkBright, said naloxone kits are critical in treating an overdose. Ontario has mandated that naloxone kits be made available in certain high-risk workplaces — a move he called “significant and groundbreaking.”

But just making the kits available isn’t enough, he said. There are specific compliance requirements in the legislation that organizations need to take into account.

“The act sets out specific responsibilities for the employer to assign a person in charge of the naloxone kit, and that that person be trained,” he said. That includes recognizing the signs of an overdose and how to administer the product.

Another key consideration is where the naloxone is physically stored, because it needs to be kept in a strategic location so it’s easily accessible, said Russo.

“Many workplaces have multiple sites, they have multiple shifts,” he said. There are also climate considerations, because the kits are temperature sensitive to both extreme cold and extreme heat.

“I’ve spoken with workplaces that have handed out naloxone kits to their supervisors, and instructed them to lock them in the desk to avoid them from being misplaced or taken home,” said Russo. “You want to avoid that. It needs to be really accessible.”

Lilian Riad-Allen, senior director, workplace health, safety and wellness at the Liquor Control Board of Ontario (LCBO), said prevention can go a long way in preventing overdoses. One of the tactics it takes is to create a culture where people feel comfortable speaking up.

“How do we create safe spaces where people feel comfortable to come forward and identify risks,” she said. “It may be just noticing when someone may not be themselves… and creating an opportunity to have those check-ins to connect with someone, to look for those signs of impairment.”

The goal is to treat an opiate overdose or poisoning in the workplace the same way any other medical event is treated, she said, just like a cardiac event or any other situation that required medical intervention.

“Our approach is to always have the person’s best interests at heart,” she said.

How the person is welcomed back to the workplace following an overdose is also critical, said Riad-Allen. Two things happen upon preparing for that return, she said.

“The first is a conversation with the affected individual, where we let them know in advance what the conversation with the team will look like — which is that we will always preserve people’s confidentiality and privacy related to any medical situation,” she said.

The second is what she called a “huddle” with the person’s manager to equip them and prepare them in advance.

“We provide them with scripts of things they can say, and things they can’t say,” said Riad-Allen.

But she stressed that the best opportunity for organizations isn’t how to respond to an event, it’s to prevent it in the first place.

“This goes back to that duty to inquire, but also created a safe psychological space for someone to come forward and share,” she said. “Whether it’s that they’re using opiates, or that they have any other kind of impairment that may affect them in the workplace.”

She also recommends implementing a “robust system” to prevent reoccurrence. That could include working with the person’s family — with the person’s consent, of course.

“We have had really good success working with collateral partners, whether that be family support partners but also bridging and creating those supports as part of a return to work plan,” she said.

The language Riad-Allen uses in these situations is always focused on safety, she said. “That’s the language we always use. Safety is the root and the anchor of everything we talk about,” she said. “People, intuitively, can appreciate that what we’re putting in place isn’t punitive. It is for their safety and the safety of their colleagues.” •