Communications toolkit for employers of men in trades: Presentation

Men in trades, substance use & the opioid overdose crisis

Government of Canada

• Since 2016, there have been over 26,690 opioid-related deaths in Canada
• On average, 20 people die per day in Canada
• 17 are hospitalized per day in Canada
• In 2021, (January to September), 86% of opioid-related deaths involved fentanyl, a very strong opioid that is now being found in other illegal drugs

• Over-reliance on opioid prescriptions
• Increase in diverted or illegally produced opioids
• Unprecedented rise in synthetic opioids (e.g., Fentanyl)
• fentanyl dominates illegal market & is mixed with other drugs causing toxic illegal drug supply

Presenter notes

• The opioid overdose crisis started by high opioid prescribing, causing some to become dependant
• Then opioids were being illegally made and sold
• Because of demand, strong synthetic opioids (like illegally produced fentanyl)
  started infiltrating the illegal market
• Now, most opioid overdose deaths are caused by people looking for strong opioids like fentanyl,
  by mixing drugs or by taking other illegal drugs that contain fentanyl (sometimes without knowing)

• Since 2016 around 3 out of 4 opioid-related deaths were men
• Men in trades are overly represented:
• of people who were employed at the time of death, 30 to 50% were employed in trades

Presenter notes

• The opioid overdose crisis in Canada is taking a toll on men in particular and specifically men who work in the trades and construction industries.
• Men account for around 3 quarters of opioid-related deaths in Canada
• In fact, 30 to 50% of people who were working at the time of their death were employed in physically demanding jobs.
• Work-related injuries, stress and pain are common for people who work in construction or trades. Some people may not have or know where to find the resources they need to take care of these issues, which can lead to using pain medications and other substances more often to cope.

• Many trades workplaces have a "work hard, play hard" culture, especially outside of work
• Men are more likely to use substances to cope with stress or mental health issues
• Men are less likely to reach out for help because there is a pressure to be "strong"

Presenter notes

• Some trades and construction workplaces have a "work hard, play hard" culture. This can reinforce heavy alcohol and other substance use after work, which can expose people who may be susceptible to addiction to situations that might be harmful to them.
• Pain is common among workers in physically demanding occupations, with 60 to 75% reporting ongoing musculoskeletal pain, and men are less likely to acknowledge and seek care for pain, more likely to receive high doses of prescription opioids, and more likely to use alcohol and other substances as coping strategies.
• The stigma associated with substance use is severe, and masculinity-related expectations to be independent, self-sufficient, and invulnerable means less help seeking and makes it more challenging to reach them with services. Add to this lack of paid sick leave and fear of job loss.
• Trades workers may not talk about substance use problems at work for fear of losing their jobs.
• But conversations can happen elsewhere with those that they can trust, such as family and friends.

• Hard, physical labour takes a toll on the body
• It increases the risk of injury and can result in pain
• When taken properly, pain medication,
  like prescription opioids, can help people
  manage pain
• But some take higher doses of opioids or seek illegal opioids to keep working through pain which creates a higher risk for addiction & harms

Presenter notes

• Work-related injuries and associated pain are relatively common among people working in construction and other physically demanding occupations, the majority of whom are men.
• Given the lack of alternative treatments, pain medications such as opioids are often the only available option to help manage pain.
• Men are less likely to acknowledge and seek care for pain. They may come back to work before they are ready and take higher doses of opioids or seek opioids from the illegal market to help manage their pain.
• This increases the risk of addiction and opioid harms and death.
• Preventing the problem before it happens can be thought of as looking 'upstream' to prevent health problems that may occur further 'downstream' — that's why it's important to have adequate training and safety protocols at job sites to prevent injuries.
• In the long term, injuries and pain can lead to loss of work for the individual and for companies the loss of a valuable workforce.

• We need to talk about the impact addiction and substance use is having on our friends and coworkers
• Reducing the stigma of seeking help and sharing resources can help save lives
• Learning more about how to use prescription opioids safely, combining pain treatments, and ways to help others who may be struggling with addiction will also save lives

Presenter notes

• A healthy workforce benefits everyone, especially when there is a shortage of skilled workers.
• The culture of our workforce needs to change to be more receptive.
• We can also help those using substances to reduce the harms and be safer.

Presenter notes

• Addiction is not a choice or a moral failing, it's a treatable medical condition.
• It changes the brain and body causing a person to have intense cravings for the drug or alcohol that are beyond their control, making it hard to stop even if someone wants to.

Presenter notes

• People use substances for many reasons, like for pleasure or to manage pain, but no one chooses to become addicted.

Presenter notes

• The misconception that people with addictions can just "stop using if they want to" is causing stigma. It makes people feel that it's their fault, it stops people from understanding that addiction is a treatable medical condition that deserves the same compassion as any other medical condition (like cancer)
• This is preventing people from asking for help for fear of judgment

When someone is affected by an addiction:

• They experience powerful cravings for the drug (or alcohol) that are extremely hard to ignore
• They continue using even though it may cause harm to themselves or others
• The need to obtain the drug/alcohol often overtakes their normal social behaviours
  and their ability to get help
• They may be unable to stop, even if they want to

Presenter notes

• Addiction changes the brain's "reward" system
• When someone is affected by an addiction:
  • They experience powerful cravings for the drug (or alcohol) that are extremely hard to ignore
  • They continue using even though it may cause harm to themselves or others
  • The need to obtain the drug/alcohol often overtakes their normal social behaviours and their ability to get help
  • They may be unable to stop, even if they want to

• Counselling
• Peer support
• Abstinence
• Medical treatment (e.g. opioid agonist therapy)

Presenter notes

• Recovery is possible and looks different for everyone.
  • Recovery from addiction is possible but the pathway looks different for everyone. Some people may benefit from non-use/abstinence, whereas others may need different support, which could include medications, counselling, and withdrawal management.
  • Resources are available to help if you or a friend is struggling with substance use.
  • With the right supports, it is possible for you to improve your or their health.

Stigma surrounding addiction can:

• Create barriers
• Prevent people from asking for help
• Lead people to use drugs alone

Presenter notes

• Stigma, in the form of negative words, attitudes, and behaviours, can create barriers to accessing appropriate and compassionate health and social services. Stigma can make people who use drugs worry that others will not be kind and respectful towards them, which can prevent them from even reaching out for help. Sadly, this can lead people to use drugs alone.
• We know that many accidental overdose deaths occur when people are alone, so it is very important to do what you can to speak and act compassionately about people who have an addiction.
• It's important to share messages of hope: addiction has one of the highest rates of recovery among all mental conditions.

• Help reduce stigma
• Be a buddy and support your crew
• Remember that addiction is a treatable medical condition, not a choice
• Don't judge, just listen
• Don't use slang such as "addict" and "junkie"
• Let them know that support is available

Visit Canada.ca/EaseTheBurden for more resources available to you

Presenter notes

• Stigma can cause people to hide their drug use and use drugs alone, which can result in overdosing and dying alone.
• By reducing stigma we can help to break down these barriers to getting help.

• A lot of focus is put on being strong in physically demanding jobs
• People may not ask for help for fear they may be seen as weak, be judged, or get in trouble
• But addiction is not a choice, it's a heavy burden to carry alone
• We can make it easier for those who may be struggling if we share and normalize that it takes real strength to ask for help

• Using only medication may not take away your pain
• Treatment options (e.g., medication, exercise, movement, physical activity, physiotherapy, massage therapy or speaking to a psychologist) are most effective when used in combination
• Opioids, like all medications, come with risks and potential serious side effects

Presenter notes

• Talking to your healthcare provider about opioids
• Opioids are medications that are prescribed to treat pain. When taken properly, prescription opioids can help people manage pain. As with all medications, opioids have risks and potentially serious side effects.
• If you are prescribed an opioid, it is important to have a conversation with your healthcare provider—such as your physician, surgeon, or nurse practitioner, to find out if this medication is right for you, and how to use it safely.
• Using only medications will not take away your pain. Talk to you healthcare provider about other parts of your treatment plan like exercise, movement, and physical activity, or about getting help from other treatment like physiotherapy or massage or speaking to a psychologist.

Side effects:

• Impotence in men
• Nausea and vomiting
• Difficulty breathing
• Headaches, dizziness and confusion

Presenter notes

• Know the potential short term risks of using opioids. For example, short term effects can include:
  • Impotence in men
  • Nausea and vomiting
  • Difficulty breathing
  • Headaches, dizziness and confusion

• Physical dependence
• Liver damage
• Worsening pain
• Addiction

Presenter notes

• Examples of long-term effects may include:
  • Physical dependence
  • Liver damage
  • Worsening pain
  • Addiction

• Always follow the instructions
• Use the lowest dose possible
• Take for the shortest amount of time possible
• Ask your healthcare provider about alternatives to treating pain

Presenter notes

• If you are prescribed an opioid, make sure you:
  • always follow the instructions given to you by your healthcare provider
  • use the lowest dose of opioids possible to control your pain
  • take the medication for the shortest amount of time possible
  • have regular check-ins with your healthcare provider to discuss how the medication is addressing your pain
  • get naloxone—more on this later in the presentation
• Other treatment options
  • It is important to discuss how best to manage your pain with your healthcare provider, particularly if your pain is expected to last more than 1 to 2 weeks. Opioids may not always be the best treatment option for your pain. Other medications or treatment options that do not use opioids may be available to help you manage your pain.

• You can't see, taste or smell fentanyl
• Fentanyl is being added to many illegal drugs

Presenter notes

• However, Canada's illegal drug supply is increasingly being contaminated with illegal fentanyl
• It can be mixed with other drugs such as heroin and cocaine, and is also being found in counterfeit pills that are made to look like prescription opioids
• 86% of accidental opioid-related deaths in Canada involve fentanyl
• There is no way to know how much fentanyl has been mixed into illegal drugs because you can't see, smell or taste it
• Many overdoses have occurred in individuals who were not aware they were consuming fentanyl
• Consuming as little as a few grains of salt worth of fentanyl can kill an average-sized person

• Blue lips or nails
• Dizziness and confusion
• Can't be woken up
• Choking, gurgling or snoring sounds
• Slow, weak or no breathing
• Drowsiness or difficulty staying awake

Presenter notes

• How can opioids cause an overdose?
  • Opioids affect how your brain controls your breathing. If you take more opioids than your body can handle, you will start to show signs and symptoms of an overdose
• If you use illegal opioids or other street drugs:
  • don't mix them with alcohol or other drugs
  • don't use alone—stick with a friend
  • know the signs of an opioid overdose
  • carry a naloxone kit
  • get your drugs checked at a supervised consumption site
• Overdoses can happen if you take an opioid:
  • that was not prescribed for you
  • above your prescribed dosage
  • with alcohol or other drugs
  • that has been tampered with
  • that has been illegally produced or obtained
  • after a period of non-use

• can temporarily reverse the effects of an opioid overdose within 2 to 5 minutes.
• An overdose is always an emergency. Even if naloxone has been administered,
  always call for help.

Presenter notes

• What is naloxone?
• Naloxone (pronounced na-LOX-own) is a fast-acting drug used to temporarily reverse the effects of an opioid overdose
• Naloxone can restore breathing within 2 to 5 minutes
• Naloxone is safe for everyone of all ages
• It works only if you have opioids in your system
• It is safe to keep on-hand because it cannot be improperly used and does not create dependence
• Why does naloxone work only temporarily?
• Naloxone is active in the body for only 20 to 90 minutes, but the effects of most opioids can last longer
• This means that the effects of naloxone are likely to wear off before the opioids
  are gone from the body, which could cause breathing to stop again
• Naloxone may need to be used again, depending on the amount, type or method of consumption of the opioids (e.g., oral, injection)
• An overdose is always an emergency. Even if naloxone has been administered, always call 9-1-1, or your local emergency number
• In Canada, two types of take-home naloxone kits are available:
• Naloxone Nasal Spray is sprayed directly into the nose where it is absorbed. It starts to take effect in 2 to 3 minutes
• Injectable Naloxone is injected into a muscle in your body: the upper arm, thigh or buttocks are best. It starts to take effect in 3 to 5 minutes

• Take-home naloxone kits are available at most pharmacies or local health authorities
• No prescription is needed
• Go to Canada.ca/opioids and search for "naloxone"

Presenter notes

• Take-home kits are available at most pharmacies or local health authorities; no prescription is needed.
• Whether you are prescribed opioids or you use them illegally, you should carry a naloxone kit.
• Some provinces and territories also offer free kits. You can consult your provincial, territorial or local health authority to see where these kits are available.

Even if you've taken drugs or have some on you, the Good Samaritan law protects you from:

• simple drug possession charges
• violation of conditions regarding simple possession in:
  • pre-trial release
  • conditional sentence
  • probation orders
  • parole

In other words, you will not get in trouble if you are high or have some drugs on you if you are calling to save someone's life.

Presenter notes

• If an overdose occurs, the number one priority is saving that life by calling 9-1-1 or your local emergency number

• Men in trades
  Canada.ca/easetheburden
• Wellness Together Canada
  wellnesstogether.ca

Presenter notes

• Whether you are looking for help for yourself, a friend or a family member, support is available.
• Visit Canada.ca/easetheburden for more information
• Wellness Together Canada provides mental health and substance use support for Canadians - https://wellnesstogether.ca/en-CA

Canada