“There’s a Lot of Pressure To Work”: An Interview with Chris Lalevee, Construction Industry Harm Reduction Advocate
The Centers for Disease Control and Prevention noted that construction and extraction workers have the highest overdose rates of any industry. More than 12,000 construction workers died of overdose in 2020. Chris Lalevee aims to do something about it.
Lalevee is a business agent with the International Unit of Operating Engineers 825 in New Jersey, and leads the union’s member assistance program. He is a co-founder of The Alliance for Naloxone Safety in the Workplace, an effort that equips employers with information and tools to make their workplaces safer.
This interview has been edited for length and clarity.
Jessica Shortall: Chris, can you put the overdose numbers in the industry into context?
Chris Lalevee: If a guy running a crane is injured, he can stay at home and make zero dollars, or take a pill and get to work. I’ve seen a guy take one Percocet or oxy to get through the workday, and soon he’s up to six a day. For years it felt like there was a pain clinic on every corner, then we started limiting prescribing without giving people the chance to wean off. What happens if you have a 40-pill-a-month habit and suddenly you can only get 15? People don’t understand that people using opioids like that are not trying to get high, they are trying to keep themselves from getting sick from withdrawals. They can’t just stop. So they’re going to go to the street, which is very dangerous.
Shortall: When people do develop a substance use disorder, are there clear pathways to recovery?
Lalevee: There’s a lot of pressure to work. Let’s say at the end of the shift the foreman says, “We’re gonna do an extra hour.” Do you leave to get to your support meeting and piss off your foreman? Do you tell your spouse you gave up overtime pay? This is what this industry is faced with, even if it doesn’t know it. We live in a very “don’t ask, don’t tell” environment.
Shortall: You do a lot of one-on-one outreach and support. What does that look like?
Lalevee: I recently did a naloxone presentation at a construction company. Afterward, one older guy told me, “I’m addicted to heroin.” He had surgery, then took prescription opioids, then moved to heroin. I told him he was probably addicted to fentanyl, because it’s often sold as heroin. I said, “You only have so many times of taking that stuff before you could die.”
He wanted help but needed a couple of days to tie up some loose ends. I knew he was going to keep using, because it’s not possible to just stop. He would be too sick. So I trained him and his wife in how to use naloxone. When he called me from the car on the way to treatment, I was finally able to breathe.
Shortall: Have you faced barriers to getting naloxone on job sites?
Lalevee: Covering costs is the biggest pain. I get some free naloxone because I am set up as a harm reduction entity with the state. We recently outfitted 150 naloxone kits to two companies. We covered 50 kits, they had an entity from their county donate 80 kits, and another harm reduction group donated 20 kits.
Some people say we are enabling drug use by having naloxone on job sites. I ask them, “If you have a defibrillator on site, are you encouraging people to eat poorly? Who made it your decision about which first aid items get to be onsite?”
Some employers worry about liability. We have a model workplace policy on The Alliance for Naloxone Safety in the Workplace website. We educate employers about state naloxone laws, including immunity for people who give someone naloxone when they believe they’re overdosing.
Shortall: Where are you making headway with employers?
Lalevee: I recently went to a company in Philly to talk about alcohol. These guys are die-hard Eagles fans, so Monday morning is awful for this company. I talked about drinking water, stopping drinking at halftime. I said I’m a Steelers fan, I drink a bit when I watch games, so I get it. We talked about what it’s like to show up to work 16 Mondays in a row hungover and why that’s a problem.
When company leaders ask me to talk about overdose prevention, I need to be sure they’re on board with what it will take for people to truly be supported. I need to be able to tell people, “If you have an appointment at 4:30, you can tell your leader. If you’re going to be 10 minutes late every morning because you need to get to the methadone clinic, they get it, and they’ll be okay with it.”
Shortall: Beyond naloxone, do you engage in other aspects of harm reduction and recovery?
Lalevee: I went to a city council meeting in my hometown recently to speak in favor of opening a methadone clinic. If we say we want people to get into recovery, it has to be nearby for them to be able to stick with it.
Shortall: What’s your guiding philosophy for all of this work?
Lalevee: I have to respect you for who you are and where you’re at. If we don’t do that, if we just expect people to change, that is not how change works.
To learn more, check out:
Lalevee’s recent article on the opioid crisis and the construction industry in New Jersey Construction magazine
The American Public Health Association’s recent coverage of opioid overdose deaths in the construction sector
The Center for Construction Research and Training’s “Resources to Prevent Opioid Deaths in Construction”