Construction workers and tradespeople have been hit especially hard by Ontario’s opioid crisis, according to a new report examining deaths between 2018 and 2024.
Among people whose occupation was recorded, roughly one-third of opioid toxicity deaths involved workers in construction or skilled trades.
The findings show that opioid-related harm is not limited to any single social group. People working in many industries died from opioid toxicity, but the risks and circumstances differed considerably depending on the type of work they did.
Opioids include prescription pain medicines as well as drugs such as heroin and fentanyl. They can reduce pain, but they can also slow breathing, and a high dose or an unexpectedly strong supply can cause a fatal poisoning, often called an overdose or opioid toxicity.
The opioid crisis has become particularly dangerous because illegal drug supplies can contain highly potent fentanyl and other substances in unpredictable amounts. Someone may therefore consume a drug without knowing its true strength or everything it contains.
Researchers from the Ontario Drug Policy Research Network, based at St. Michael’s Hospital and Unity Health Toronto, examined population health data provided through ICES. They studied opioid toxicity deaths in Ontario from January 2018 through December 2024 and compared patterns across different occupational groups.
Almost 16,000 people died from opioid toxicity in Ontario during that period. However, occupation was included in coroner records for only about 3,500 of those who died, and these were the people included in the occupation-focused analysis.
Construction and trades stood out clearly. Workers in these fields had the highest opioid toxicity death rates among the occupational groups studied, and the rates increased during the study period.
Deaths rose considerably during the COVID-19 pandemic and remained high afterward. Senior author Tara Gomes said several overlapping factors may help explain why workers in construction, trades and mining face greater risks.
These jobs are often physically demanding and can involve injuries or long-term pain. Workers may be exposed to prescription pain medicines, struggle to find effective pain treatment or have difficulty accessing addiction and mental health services.
Many of these industries are also dominated by men, and workplace cultures can sometimes make talking openly about pain, mental health or substance use difficult. Workers may fear judgment, job consequences or being viewed as unable to perform physically demanding duties.
Study co-author Andrzej Celinski, who has worked in construction and has lived experience related to substance use, said workplaces could become an important place for prevention. Making naloxone, overdose-response training and connections to treatment more available could reach workers who might never use traditional health or social services.
Naloxone is a medicine that can temporarily reverse the effects of an opioid overdose and restore breathing. However, the report emphasizes that emergency response alone cannot address the deeper causes of opioid-related harm.
Other industries were also affected. Manufacturing, hospitality and retail workers each accounted for close to 10% of deaths among people with a recorded occupation, while transportation, warehousing and equipment-related jobs also showed consistently high death rates.
Deaths among civic and government workers, including occupations such as police, military personnel and firefighters, increased during the study period. These jobs can also involve injuries, chronic pain, psychological stress and other pressures that may increase vulnerability.
The researchers found another concerning pattern involving employment itself. About one-third of the people who died were unemployed at the time of death, suggesting that losing a job or leaving work because of injury, pain or mental health difficulties may create an especially vulnerable period.
Most opioid toxicity deaths were classified as accidental. However, civic and government services, health care, and administrative, financial and support occupations had higher proportions of opioid deaths classified as suicide, highlighting the need for mental health support alongside overdose prevention.
The report was released by the Ontario Drug Policy Research Network, with researchers drawing on population-based health data from ICES. It argues that prevention strategies should be designed around the different realities workers face rather than relying on one approach for every industry.
The findings are important, but there is a major limitation: occupation information was available for only about 3,500 of nearly 16,000 opioid toxicity deaths. This means the occupational patterns may not perfectly represent everyone who died, especially if occupation was more likely to be recorded for some groups than others.
The study also cannot prove that working in construction or another industry directly causes opioid toxicity. Factors such as pain, income, housing, mental health, drug supply, treatment access and employment instability may all contribute and may overlap in complicated ways.
Still, the report provides a strong reason to bring prevention closer to where people live and work. Safer workplaces, better pain care, less stigma, naloxone access and easier connections to addiction and mental health treatment could help reach people before a private crisis becomes a fatal one.
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Source: Ontario Drug Policy Research Network.
