I mean, some work sites might also worry that somebody having narcotic withdrawal might become aggressive when they get revived. This is a very, very rare problem.
SPEAKER: Welcome to the WTW podcast, Construction Blueprints, where we discuss the latest risk management and insurance trends, as well as issues facing the construction industry. We'll speak with a variety of construction leaders and experts on global topics, who can help provide you a blueprint for building your industry knowledge.
JON OPPENHEIM: Hello and welcome to our WTW Construction Blueprints podcast. I'm Jon Oppenheim, WTW's Southeast Region Construction Leader, the podcast host. And I'm delighted to be joined by Jeff Levin Schurz, M.D., a Physician, Managing Director at WTW, and our North American Population Health Leader. Welcome, Jeff.
JEFF LEVIN-SCHERZ: Thanks, Jon. It's great to be on with you today.
JON OPPENHEIM: In this episode, we'll explore the use of Naloxone as a potential life saving practice in the construction industry. This is an incredibly important topic. So let's jump right into it. Fatal drug overdoses have doubled in the U.S. since 2015. From your perspective, what do you think are the underlying issues or reasons?
JEFF LEVIN-SCHERZ: Jon, I mean, the drugs that people are overdosing on now are very dramatically different than the drugs that people are overdosing on 20 or 30 years ago. For one thing, we have fentanyl and other synthetic narcotics. They're much easier to produce. They're much harder to interdict importation. They're also easy to mix with heroin, cocaine, even marijuana, even to put into ADHD medications.
So many people who take fentanyl actually aren't even aware they've taken it. But the impact, in terms of respiratory depression and potentially death from taking fentanyl, are just dramatically higher.
By the way though, once I start talking about the danger of fentanyl being much higher, I do feel a need to mention that there really is very little risk to first responders. So there have been some reports of police or others who are made sick by getting just a little bit of this on their hands. And generally, that hasn't proven to be true.
I think that there are a bunch of reasons. There's probably more depression, post-pandemic, too. But really, the problem is, we have different drugs now than we used to have.
JON OPPENHEIM: We know that construction ranks among the highest of any industry for narcotic misuse and abuse. How can you recognize a drug problem at the workplace?
JEFF LEVIN-SCHERZ: Sure. First of all, let me think a little bit about how do you recognize somebody who might be misusing narcotics. This could include identifying that they aren't paying attention like they used to, their quality of work might go down. Perhaps you will find drug paraphernalia, but more likely, you won't.
An overdose is when somebody really loses consciousness, and their respiratory rate is depressed. So, essentially, people stop breathing. And they'll die if they're not treated. And there are other causes of unconsciousness, other than narcotic overdoses. People can be hit in the head, whatever. But narcotic overdose is very, very common.
So if people encounter somebody that's unconscious without another good explanation, they should always be treated as if they might be a narcotic overdose.
JON OPPENHEIM: If you believe someone has a drug overdose, what should you do?
JEFF LEVIN-SCHERZ: Well, the first thing is, try to arouse the person. I mean, maybe they've just taken a sudden nap or something. But then, assuming that there is Narcan, the generic name of it is naloxone, in the first aid kit, get some. Insert the tip into the person's nose. Push the plunger to discharge the medication. Call 911. And stay with the person.
Generally, if somebody has a narcotic overdose, one dose of naloxone will actually revive them. However, the narcotics, especially fentanyl, lasts substantially longer. So they could need a second dose. If they are not revived by that one dose, a second dose can be given a few minutes later as well.
JON OPPENHEIM: You mentioned Narcan, a specific brand name, and naloxone. How do they work?
JEFF LEVIN-SCHERZ: Well, essentially, what naloxone is it's a narcotic antagonist. So what it does is it binds to the receptors that would otherwise lead to the narcotic working. It doesn't give a high. It doesn't depress breathing, like narcotics do. But it keeps narcotics from exerting that impact on the brain, either to give a high, or to depress breathing.
So chronic narcotic users, people who are using heroin or anything else over a long period of time, can actually get symptoms of withdrawal from naloxone. And that includes a lot of gastrointestinal upset. It also can include some irritability. But again, just to emphasize, naloxone is pretty short-acting.
So the good news is, when you squirt it in someone's nose, it gets into the bloodstream very, very quickly. So it acts quickly. But it also leaves the system pretty quickly. So because narcotic overdoses tend to last longer than Narcan doses, it's really critical to call 911. And send anybody who's been revived by Narcan, should really be evaluated in an emergency department setting.
The other value of being seen in an emergency department is, this way, the person can also be referred for treatment for the underlying substance use disorder.
JON OPPENHEIM: There's a lot of concerns around administering naloxone. If you're wrong, and a person doesn't have drug overdose, are they harmed by getting a nasal dose of naloxone?
JEFF LEVIN-SCHERZ: No. So it's a very, very safe drug. Very few people are allergic to it. If somebody doesn't have depressed consciousness or breathing from a narcotic, then naloxone will probably simply have no effect on them. If you or I had a spritz of Narcan in our noses, and we are not using narcotics now, it would essentially not make us feel any different.
JON OPPENHEIM: All right. If naloxone is simple to administer, it's highly effective, not very expensive, you'd think it would be included in a contractor's first aid kit? What are the concerns that keep some worksites from having naloxone?
JEFF LEVIN-SCHERZ: This is a really good question, and also a really important reason why we're talking together on this podcast . So some worksites might falsely believe that since narcotics are forbidden at the worksite, this just simply shouldn't be a problem, or they might even think that having naloxone might make people feel more of a sense of license that they can misuse narcotics at or near the workplace.
I mean, some worksites might also worry that somebody having a narcotic withdrawal might become aggressive when they get revived. This is a very, very rare problem. Usually, by the time that happened, there would already be EMTs on site. And it's unlikely somebody will become aggressive while they're going through narcotic withdrawal, right after they've been resuscitated. But it's better to have that than somebody who's unnecessarily died.
JON OPPENHEIM: From a practical perspective, how should a naloxone program be designed?
JEFF LEVIN-SCHERZ: I think the first step is assessing whether there's a need. My own hope is, over time, that pretty much every workplace, not just construction worksites, but every workplace would have it as much as we're using automated external defibrillators, AEDs. And having those available everywhere can prevent people from dying from heart attack.
So I'm hopeful that all work sites will eventually have these. But for right now, first, you assess the need. Be sure there's a place to store it. Be sure there's staff that are willing to be trained. Then you have to develop written policies and procedures, train the staff. The policies should always include calling 911, even if the revived person says, no, I'm fine, I don't need it. Really, 911 should be called.
You got to get naloxone. You've got to have the appropriate personal protective equipment, offering gloves. They don't have to be sterile. Offering masks, if people want to wear them. And periodically, things need to be reviewed. People need to be retrained. If they haven't used naloxone, and were trained a while ago, they need to be retrained.
Also, you need to have a process in place to replace used or expired naloxone. I mean, in my ideal world, all naloxone expires because no one needs to be resuscitated. But we know that that's not true.
These are basic steps to putting together a naloxone program. There are consultants, obviously, that can help with this as well. There are really good set of guidelines from the National Institute of Occupational Safety and Health, which can be very helpful as construction workplaces are thinking about how to design their program.
JON OPPENHEIM: Thanks that's really helpful guidelines from a practical perspective. Is naloxone administration considered first aid, or is it medical treatment?
JEFF LEVIN-SCHERZ: Well, medical treatment is administered by a professional. And naloxone can be given by people who have no professional training whatsoever. So it's most certainly first aid, and not medical treatment.
A related issue, which is worth mentioning is, is this a reportable incident if naloxone is used at the worksite? And I think, basically, that depends on local and state regulations. That might be different from place to place. But nobody should think that having naloxone in a first aid kit means they've become a medical facility. They absolutely have not.
JON OPPENHEIM: Some construction sites have worried that if naloxone is available, it might increase liability. What could they do to mitigate the risk?
JEFF LEVIN-SCHERZ: First thing is, obviously, having clear written procedures and policies, and being sure those policies and procedures are respected and in place. I think that's especially important. I'm not a lawyer. So listeners definitely should check with their own counsel as they develop policies and procedures.
Clearly, having staff training with annual refreshers is important. Being sure that the naloxone that's in the first aid kit is not expired. And being sure that if it's supposed to be in the first aid kit, but it's been used, or it's walked away, that it be replaced, is important. Terrible for people to open up that first aid kit and find that it's not there.
Honestly, though, if somebody had a choice between using expired naloxone and no naloxone, you'd use the expired stuff. But liquid medicines tend to lose their potency somewhat more quickly than pills.
I think, providing staff with appropriate personal protective equipment is important. And if you don't have naloxone, then the alternative to resuscitate somebody is to use mouth-to-mouth resuscitation. Much less likely to be successful than naloxone use, and presents much larger risks to the first responders.
So in a sense, I think that liability for the workplace might actually be lower having naloxone in place. But again, with always the caveat, don't rely on me for legal advice. This is just my perspective.
JON OPPENHEIM: Thank you very much, Jeff. Any closing words?
JEFF LEVIN-SCHERZ: Thanks, Jon. So over 100,000 in the US died of drug overdoses last year. Many were exceptionally young. Every one of those deaths was tragic. And many of those deaths were preventable.
So those who run construction sites know better than most, that safety procedures save lives. And think about having naloxone around, really, as a safety procedure. And hope you'll never have to use it. But if you do, you can prevent an avoidable tragedy.
And one more thing, listeners can go to the WTW Construction Blueprints web page, this podcast's web page, for additional resources, including information from the Surgeon General, and the Centers for Disease Control and Prevention, and the National Safety Council. And once again, thanks very much for the opportunity to talk about this.
JON OPPENHEIM: Well, Jeff, thank you for contributing to this episode, and for sharing your perspectives on really such an important topic. Thank you to everyone who listened. And thank you for joining the WTW Construction Blueprints podcast. We'll talk to you on the next one. And stay well.
SPEAKER: Thank you for joining this WTW podcast, featuring the latest thinking and perspectives on people, capital, climate, and risk in the construction industry. For more information, visit wtwco.com.
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