Injured Workers and Opioids

By Maia Rosenfeld

One day in 1997, Steve Reid, of Warwick, injured his shoulder while moving kegs of beer off a truck for his job at Budweiser Corporation. He went to an orthopedic surgeon who had previously treated his brother, and after a surgery to remove the spur in his shoulder, he received a prescription for Vicodin — 120 tablets at a time, which he refilled every couple of weeks. Soon, Reid was hooked on this highly addictive opioid medication.

It would take him 12 years to break the addiction. After losing many acquaintances to opioid overdoses, he relapsed in late 2016. Today, Reid, 54, has been in recovery for three years.

Reid's story is all too common in industries that have high rates of work-related injuries and no paid time off. Data from the Rhode Island Department of Health shows that a quarter of overdose deaths in the state from July 2016 through June 2018 were among carpenters, laborers, construction workers, electricians and commercial fishermen. Of these 140 fatal overdoses, 20 percent comprised workers in the construction industry. Eighty percent of the 140 overdoses involved fentanyl, an extremely potent opioid that labor union leaders say has become more common among laborers in recent years.

Michael Sabitoni, Business Manager of the Rhode Island Laborers' District Council and President of the Building and Construction Trades Council, sees the effects of the opioid epidemic on workers every day. "I've seen members impacted by it, I've lost members," Sabitoni says. "I've seen members through the other trade unions — electricians, plumbers, carpenters, iron workers ... it doesn't discriminate."

The disproportionate rates of fatal opioid overdoses among workers in these fields is due in large part to the prescription of opioids for chronic or acute pain resulting from workplace injuries. Sabitoni says the strenuous nature of these occupations lends itself to such injuries.

"Working class people — fathers, mothers, sons and daughters — they get hurt on the job, they go to the doctor, the next thing you know, all they want to do is pop those pills," says Paul MacDonald, President of the Providence Central Labor Council. "There are people that immediately get addicted."

Especially in jobs where workers can't get paid while they rest and recover from injuries, they are motivated to do whatever it takes to get back to work to provide for their families, labor leaders say. Although injured workers can receive workers' compensation benefits if they need to take time off of work to recover, these benefits do not cover their full pay, and they also don't contribute to annuity or pension payments.

There is also a stigma associated with relying on workers' compensation, laborers say, and injured workers may be too proud to rest if they are able to keep working. Until recently, opioids were presented as the only solution for injured workers who wanted to get back to work, and other pain management options were rarely offered.

Reid says he was not presented with any alternatives to opioids to treat the pain from his workplace injury and resulting surgery. He was out of work for over six months due to his shoulder injury and was on workers' compensation during that time.

Reid eventually returned to work, this time for a different employer, Quality Beverage in Taunton, Massachusetts. But he was still dependent on opioids. He'd started boxing again, something he'd enjoyed since age 13, and now he was taking 30 or 40 tablets of Vicodon before each fight — far more than the recommended maximum dosage of 8 tablets a day.

Steve Reid boxing in 2008, when he loaded up on opioids before each fight.
Steve Reid boxing in 2008, when he loaded up on opioids before each fight. Photo courtesy of Steve Reid.

Shopping for pain pills

Reid obtained opioids through a complex system of prescriptions and refills from multiple physicians and pharmacies. He paid for the opioids through a combination of his health insurance and workers' compensation. The orthopedic surgeon who treated his shoulder injury through the workers' compensation system was Dr. Christopher Huntington, who would later be stripped of his license to practice for overprescribing opioids. Huntington committed suicide on the same day his license was suspended in 2013.

But to Reid, Huntington was just a nice guy who continued to prescribe him Vicodin after his injury. "This was my new pal, so I would tell him the healing was going slow, and it didn't take much," Reid recalls, adding that he "would have never pegged him as a pusher."

Reid also received opioid prescriptions from various other physicians, "doctor shopping" for providers who would write him prescriptions. "I would go to my regular family doctor and complain about pain. I would go to a walk-in, complain about pain. I think I might have had another orthopedic doctor I was going to at the time," he says, adding that the doctors who treated him were "shoveling" opioids.

Reid filled these prescriptions at five different pharmacies in Rhode Island on a rotating basis. At the time, the pharmacies did not crosscheck records — something they are required to do now — so they were unaware of the amount of pills Reid was consuming. "I would actually mark on my calendar which prescription was up, which time it was filled at which pharmacy," Reid says. "It was almost like a job."

Reid filled his prescriptions at major chains including CVS and Walgreens, as well as at local establishments — Phred's Drug in Cranston and Suburban Pharmacy in Warwick. All of the pharmacies and doctors Reid used were located in Rhode Island. "I didn't have to go to another state, it was just so easy," he says.

To avoid discovery of his opioid abuse by the insurance providers that paid for his pills, Reid used different payment methods for each prescription. One of Reid's prescriptions was covered by his personal medical insurance. Workers' compensation covered another prescription, which was filled at a separate pharmacy. And Reid used cash to pay for additional prescriptions. He also made money to buy pills by selling some of his prescribed opioids on the street.

Three years after his shoulder injury, Reid injured his neck during an attempted carjacking. This actually came as a relief to him, because it meant he'd get more pills to feed his addiction. "It was almost comforting, because I knew it was going to keep me in the rhythm of receiving opiates, even at a higher volume," he says.

Reid went back to Huntington for surgery and treatment, and sure enough, the orthopedic surgeon prescribed him more opioids.

Pharmacies target injured workers for opioid prescriptions

Reid was not alone in his path to addiction. According to Stephen Dennis, a workers' compensation lawyer who has practiced in Providence since 1990, many of his clients' opioid addictions started with an on-the-job injury — and he's seen the effects firsthand.

"What I saw was just horrifying," Dennis says. "I'd get these night calls — people screaming for their medications, leaving crazy messages on my answering machine at home, scaring my wife and my child. And I'd have some real disruptive behavior in the office, to the point where I had to put in some video cameras in the office because people just were not themselves."

Meanwhile, at seminars, Dennis listened to pain management advocacy groups speak about "the right to be treated with these opioids." He also faced pressure from pharmacies to refer his clients to them, so they could profit off of the clients' opioid dependence. "There was a lot of pressure on all ends — pressure on the plaintiff attorneys, pressure on the doctors," Dennis says. "There were just tons of money being made by a lot of people at the expense of injured workers."

One pharmacy that approached Dennis asking him to promote it to his clients was the Injured Workers Pharmacy, a mail-order pharmacy that is headquartered in Andover, Massachusetts, but is licensed to dispense prescriptions in all 50 states. In June 2020, the pharmacy agreed to pay $11 million and change its business practices to settle a civil lawsuit brought by the Massachusetts Attorney General's Office. The complaint alleged that the Injured Workers Pharmacy improperly dispensed opioids to injured workers and marketed these dangerous drugs through illegal tactics, such as buying patient referrals from attorneys.

Although Dennis refused to help the Injured Workers Pharmacy get more customers, some of his clients ended up with prescriptions filled by it anyway. "The workers were getting the medications much faster and in cheaper quantities than they normally would," Dennis says. Some of his clients told him they didn't even know they'd been prescribed opioids until the pills showed up on their doorstep.

Timothy Byrne, Business Manager of Rhode Island's plumbers, pipefitters and HVAC union, also interacted with the Injured Workers Pharmacy after a representative came to the state about 10 years ago and approached him about getting union member clients, he says. The pharmacy focused on getting injured workers cheaper prescriptions, and it had its own doctors that wrote prescriptions for the workers, he remembers. "They would have a doctor get ahold of you, go through the motions and interview and everything, and then they would qualify you for the drug."

As pharmacy representatives tried to get business from workers like Dennis' clients and Byrne's members, the Injured Workers Pharmacy continued to increase the doses of opioids it acquired. From 2006 to 2014, the Injured Workers Pharmacy roughly tripled its annual purchase of opioids, according to a database maintained by the Drug Enforcement Administration (DEA). This growth was largely driven by oxycodone and hydrocodone pain pills, but also included drugs such as buprenorphine and methadone, which are commonly used to treat opioid addiction.

In this period, the Injured Workers Pharmacy acquired more opioid doses than any other retail or chain pharmacy in New England. It received 2.4 times as many doses of opioids as the second largest recipient in the region.

In a July 2019 statement to The Boston Globe -- issued in response to news of the Massachusetts attorney general's probe -- the pharmacy's lawyer, Greg Saikin, claimed its larger acquisition of opioids was because it dispensed the drugs in all 50 states.

But even nationally, the Injured Workers Pharmacy was the tenth largest recipient of opioids out of 89,020 retail or chain pharmacies across the country. The pharmacy has been operating since 2001, and it was bought by private equity investment fund Acon Equity Partners in 2014.

Injured Workers Pharmacy CEO Michael Gavin declined a request for an interview for this story.

Doses and kinds of opioids acquired by the Injured Workers Pharmacy between 2006 and 2014. Data: DEA ARCOS database. Credit: Gabriel Rizk.

Byrne says his interactions with the Injured Workers Pharmacy revolved around narcotics that were difficult to get prescribed by most doctors. The sales rep left Rhode Island about five years ago, he says, and he has had no contact with the pharmacy since.

Dennis also says the Injured Workers Pharmacy stopped knocking on his door about five years ago, and that the situation with clients begging and screaming at him to get them opioids has improved since then, after Governor Gina Raimondo established the Rhode Island Overdose Prevention and Intervention Task Force in 2015 to address rampant opioid abuse in the state.

Out of refills, injured workers turn to street drugs

Marc Lyle, 47, of Woburn, Massachusetts, is another worker who became addicted to opioids following an on-the-job injury. Like Reid, Lyle was prescribed opioids for pain management: He hurt his back while on a construction job in 1999, after years of "typical wear and tear" from working on his father's lobster boat and in construction.

Working through this injury rather than relying on workers' compensation was a point of pride for Lyle, but he needed medication to mask the pain so he could get back to work. His doctor prescribed OxyContin, instructing him to take one pill every four hours.

But soon, Lyle became dependent on the medication and was taking four pills every hour.

"When it came from a doctor, I thought, 'Well, this is how it is, it must be right,'" Lyle says. When he ran out of his prescribed OxyContin, Lyle went back to his doctor and asked for more, saying that his pain had gotten worse. The doctor told him he shouldn't be in pain anymore and refused to grant him a refill of the prescription. Although at the time Lyle believed his pain was truly increased, he now recognizes that "the disease was running the show."

With no programs in place to help laborers dependent on opioids, and no protocols for tapering patients off of this medication, Lyle was simply told to take over-the-counter painkillers and go on his way. The next day, he was buying OxyContin by the dozen on the street. "They sent me on my way with a full-blown habit," he says.

After a decade of relying on opioids — including OxyContin and eventually heroin — to keep working and stay afloat, Lyle's desperation drove him to detox and recovery. Today, he has been clean for 11 years, and he is the husband and father that he always wanted to be.

Lyle has seen many other laborers go through experiences similar to his own: "That's where a lot of it stems from — that one injury, or that one operation, relating to a job incident," he says.

The prevalence of opioid use disorders among laborers also has consequences for their employers. According to Byrne, chronic absenteeism is one of the worst problems in the industry. "The biggest complaint I get from contractors is they have to hire nine guys to get six to show up," he says.

But the obligation to show up to work is actually a driving force behind opioid dependence among laborers. "The pressure to be able to perform at work is so intense, some of them will get caught in that drug spiral," Byrne says. "And it'll start out innocently enough, with going to the doctor and the doctor will prescribe something, whether it's oxycodone or Percocet or Vicodin or something like that, and they'll take it, and they'll refill the prescription because they're performing and they're functioning."

Lyle agrees. Laborers, he says, want to be productive and take pride in continuing to work despite injuries: "You work hard, and you have to keep working through this pain. So the first thing you do is you want to get the pain management, you want to mask the pain so you can continue to work." Laborers usually don't want to rely on workers' compensation for anything but the most serious injuries, Lyle says, because if they usually work 40 hours a week, the insurance payments won't provide their typical income.

Once workers get hooked on the opioids prescribed to them and run out of refills, they often turn to the streets to feed their addiction. Many end up using heroin or fentanyl, because these are cheaper and more available.

When Lyle couldn't afford enough OxyContin anymore, he crossed a line he'd said he would never cross: He started buying heroin off the street.

"This disease became so powerful that I had to be on something on a daily basis just to be around my family," Lyle says. His daughter was born in 2004, when he was still in the throes of opioid addiction. "The love of my child wasn't enough — this disease took that over."

Road to recovery

Eventually, in 2009, Lyle "got the gift of desperation," which led him to recovery. "I was a shell of a person," he says. "I wanted to stop, but I didn't know how. I wanted to die, but I didn't want to kill myself. I just didn't want to feel like this anymore."

At that same time, Reid was in a similarly desperate place. He had recently become homeless, after years of professional boxing sustained by his opioid addiction. Feeling hopeless, he tried to kill himself. He took 90 sleeping pills and went to sleep. Miraculously, he woke up in a hospital, with a doctor who couldn't believe he'd survived.

"That was actually the real start of my recovery," Reid says.

Lyle and Reid both sought help and managed to prevail over their addictions. But many injured workers who get hooked on opioids never make it to recovery.

"If you don't get help, unfortunately nowadays people are dying left and right," Lyle says. "They're dying on the job sites, at home — their families are finding them overdosed in their own house; their co-workers are finding them on the job sites, in the outhouses."

Often, Byrne says, he finds out about workersc fatal overdoses when they don't show up to work. A co-worker or foreman tracks them down and finds out that either the worker or one of their family members has died of an overdose. Byrne estimates this happens about three or four times a month across the industry in Rhode Island. "We've lost members, members' sons, apprentices," he says.

For union workers who do reach out for help, Byrne often has to persuade contractors to lay them off instead of firing them, so they can collect unemployment benefits. The union's member assistance program then helps connect these workers to rehabilitation, which is covered by the union's healthcare insurance. In Rhode Island, unlike in most other states, workers in rehab are able to collect temporary disability insurance from the state.

Unions in Rhode Island have also been working to curb opioid addiction among their members by running educational programming about the dangers of opioids. Sabitoni has hosted a series of seminars on the topic, and he also participated in an "Opioids Awareness Week" featuring TV, radio and podcast discussions.

"We're trying to remove the stigma, we're trying to make it easy for people that need assistance to get assistance," Sabitoni says. The unions have been "really, really aggressively targeting" the opioid epidemic for about three years, dedicating a lot of money and attention to the issue. But despite these efforts, Sabitoni says he's not sure things are getting better yet.

"Maybe it's leveled off to an extent," he says. Over the last five to six years, his union has seen a spike in the use of its member assistance program. To Sabitoni, "it's good that they're using it, but it's still kind of alarming that the numbers are still continuing to rise."

Industry leaders in Rhode Island may be able to learn from their neighbors in Massachusetts, who have begun to take a more proactive approach to curbing opioid addiction among laborers. At an "Opioids and Your Workforce" seminar Sabitoni hosted in March, members of the Massachusetts Laborers' Benefit Fund showcased their recently created recovery program, LEAN: Laborers Escaping Addiction Now. The program refers workers to multiple recovery pathways, including detox, intensive outpatient rehab, sober living, 12 Step Programs, SMART Recovery, and Medication-Assisted Treatment. It also provides peer-to-peer recovery support through three Labor Recovery Specialists — former laborers who are in long-term recovery and help guide their peers through recovery, connecting them with resources, bringing them to treatment or program meetings, and offering emotional support.

Lyle is one of these Labor Recovery Specialists. He now helps laborers like his past self, who are struggling with opioid addiction. "We're in such a great position to really show people that there is hope for guys like us," says Lyle. He and his coworkers go to job sites, training facilities and union meetings to let workers know that it's okay to ask for help.

Reid has also worked to help other patients in recovery at treatment centers, first at the Phoenix House in Providence, then at The Providence Center, where he became the director of recovery housing in 2015.

In 2016, when fatal opioid overdoses peaked in Rhode Island at 336 deaths, Reid lost many residents, clients and community members to overdoses. "You just woke up the next day wondering who's gonna be on Facebook, who died," he recalls.

Steve Reid in December 2020 at Steel Curtain Boxing, the gym he opened in Warwick.
Steve Reid in December 2020 at Steel Curtain Boxing, the gym he opened in Warwick. Photo courtesy of Steve Reid.

The grief pushed him into relapse in late 2016. The following year, he went to get treatment in Mississippi. In February 2019, after overcoming his opioid addiction once again, Reid opened up his own gym in Warwick. He decided to give himself an "honest shot" at boxing, since he had always been high when he'd fought professionally. Earlier this year, he was training to fight in Australia, before the COVID-19 pandemic derailed this plan.

Although they are both grateful for their rehabilitation, Reid and Lyle have to keep working at their recovery every day. "We deal with this on a daily basis," Lyle says. "There's never going to be a cure, but there is a way out."

— Gabriel Rizk did the data sifting for this story