In August 2023, the Centers for Disease Prevention and Control (CDC) reported the first data highlighting substance overdose rates by occupation and industry level.

Construction and extraction had the highest rate among 22 major occupational groups at 162.6 per 100,000 workers. Likewise, construction was the leading industry group among 18 others at a rate of 130.9 per 100,000 workers. Additional elevated death rates were delineated for at least 17 specific construction occupations. The analysis concluded causal and contributing factors including high injury rates, opioid prescriptions for pain management, and no paid time off for sufficient injury recovery and rehabilitation.¹

With the nation’s overdose crisis now in its third decade, it continues to be driven by opioid misuse. Initially due to overprescribed medications, the crisis first shifted to heroin use with the advent of prescription drug monitoring initiatives at state and federal levels.² However, the emergence of illicitly manufactured synthetic opioids — especially fentanyl — starting in 2013 sharply increased the number of overdose deaths. As the opioid crisis continued to worsen in the U.S. (Exhibit 1), naloxone has been deployed over the past two decades by public safety and community-based harm reduction agencies to reverse overdoses.³

Naloxone is a lifesaving medication that can revive those experiencing an opioid overdose and offer them another chance at life as well as the possibility to seek treatment and recovery. Contrary to views rooted in social stigma around addiction that naloxone may enable continued drug use, without it, the U.S. overdose crisis would claim even more lives.

This article explores how naloxone provides a beacon of hope, breaking the chains of addiction in personal lives and workplaces.

A Risk Management Imperative for Workplaces

The workplace is evolving into the next frontier for opioid overdose prevention.

Community naloxone deployments by law enforcement and harm reduction organizations have successfully revived tens of thousands of persons from fatal overdoses since the mid-1990s.⁴

In March 2024, the “White House Challenge to Save Lives from Overdose” was issued using naloxone, ultimately seeking the cooperation of workplaces across the nation to provide naloxone and training to employees to reduce opioid overdoses.⁵

While there is no law or regulation that requires the provision of naloxone in the workplace, a growing number of construction employers are deciding that having naloxone available with trained staff ready to respond in a suspected overdose emergency is a sound business practice.

Understanding Naloxone

In 2018, the Office of the Surgeon General issued an advisory highlighting the benefits of naloxone for various at-risk groups, including patients prescribed high doses of opioids for pain, those misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care providers, family and friends of people who have an opioid use disorder, and community members who may encounter people at risk for opioid overdose.⁶

In 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) revised the Opioid Overdose Prevention and Response Toolkit to address naloxone’s proper storage, the monitoring of expiration dates, and broader accessibility in public settings.⁷

Naloxone is available over-the-counter (OTC) under several brand and generic names, with dosages ranging from 0.4 mg per dose up to 8 mg per dose.

The most common brand names include:

• RiVive, available in 3 mg doses
• Narcan, available in 4 mg doses
• Kloxxado, dispensed at 8 mg per dose⁸

The 4 mg per dose is the most common OTC naloxone product sold, and several products come in packages containing two doses.⁹ The U.S. Food and Drug Administration (FDA) has cautioned that higher doses can trigger severe withdrawal symptoms in opioid-dependent individuals, including increased heart rate (tachycardia), body aches, nausea, and restlessness.¹⁰

Harm reduction advocates recommend starting with lower doses, as this approach is more humane and less likely to contribute to intensifying the effects associated with opioid withdrawal.

This position was substantiated in joint research undertaken by the New York State Department of Health and the New York State Police as reported by the CDC in the Morbidity and Mortality Weekly Report in February 2024. This research found similar outcomes from administering 4 mg doses vs. 8 mg doses, except those administered 4 mg doses experienced less severe symptoms of withdrawal.¹¹

When & How to Administer Naloxone

Naloxone should be administered to any person who is showing the signs of an overdose or in cases where an overdose is suspected, even if they deny taking opioids, as other substances may have been cut or contaminated with fentanyl. The growing trend of combining opioids with stimulants like methamphetamine and cocaine underscores the need for caution in overdose situations.¹²

Historically, there have been two primary means of administering naloxone: through an intramuscular injection or via a prepackaged inhalable nasal spray. The intramuscular injection continues to be used in medical and clinical settings, in community-based harm reduction interventions, and emergency medical services by first responders. But the innovation of a nasal spray device has allowed for the mass distribution of naloxone to the general public.¹³

The “Save a Life at Work” sidebar provides step-by-step information on administering naloxone. The following are some additional tips for training on administering naloxone:

• When using the nasal spray, training on the use of the device is recommended. It is vitally important to not test or prime the plunger. Once the plunger is depressed, the medication is immediately dispensed.¹⁴
• Those administering naloxone should maintain a positive communication style that is calming and reassuring to those receiving naloxone. A small percentage of persons who have been administered naloxone in a suspected or actual overdose emergency can react angrily or be combative.

Recent research concluded that positive and reassuring communication while administering naloxone is associated with less anger vs. more anger with a negative and shaming communication style.¹⁵

Stocking Naloxone in Workplaces & Jobsites

An increasing number of contractors are stocking naloxone in standard jobsite first-aid kits or emergency response kits. Likewise, these contractors are training staff members on how to recognize and respond to a suspected opioid overdose and how to administer naloxone.¹⁶

These contractors have recognized the increasing risk of an unintentional overdose occurring in the workplace, and they are preparing for an appropriate response in case of an overdose 
emergency.

Scenario 1

Imagine an employee, supplier, vendor, or visitor at your workplace or jobsite suddenly experiencing a medical emergency. The medical emergency could be with or without witnesses and occur in a hallway or stairway, training or conference room, restroom, or even a portable restroom.

In this case, imagine that a worker stumbles and drops to the ground. A bystander who discovers the fallen worker sees a seemingly lifeless body of an unconscious person that they are not sure is breathing or only breathing shallowly. The stricken person does not respond to verbal commands or physical jostling.

The result of this medical emergency depends on a couple of key factors, including how long the person has been unresponsive, how long it took to be discovered, and the expected response time by first responders to an emergency 9-1-1 call.

Beyond those facts, two other factors will help determine the possible outcome of this case:

1. Does the workplace or jobsite stock naloxone in first-aid kits?
2. Have workers been trained on recognizing the signs of an overdose and how to administer naloxone to reverse the effects of a suspected opioid overdose?

Generally, there are two likely outcomes: