SILENT KILLERS IN THE MINING INDUSTRYSILENT KILLERS

It’s often a challenge no one wants to discuss: mental health in the mining industry.  But to acknowledge it and open lines of discussion can help treat those afflicted as well as to help prevent others from following the same dark paths.

By Joe McGuire, PhD and Lucas Simpson, M Ed

The March 8, 2023, edition of the University of South Florida’s (USF) MUMA College of Business, Student Spotlight, focused on Vince Hafeli, the president of Ajax Paving. Hafeli is not only active in his role as company president but is also a student in USF’s Doctor of Business Administration Program and a keynote speaker at conventions and conferences across the United States.

Last February, Hafeli shared his 30-minute heartfelt story with nearly 1,900 attendees at a construction conference – where his passion for construction and a serious issue within the industry stood out. 

Specifically, he spoke about mental health awareness and suicide – taboo topics in the construction industry.¹ The audience listened to Hafeli detail his mental health battle that led him to consider ending his own life in 2007. Today, Hafeli’s personal goal is to “curb suicide in the construction industry one person at a time.” 

Although inspiring, telling his story and sharing his research about mental health issues and suicide in the construction industry raises more thoughts and questions for the authors of this article about how to best proactively address these problems:

• Rarely, if ever, are topics dealing with difficult problems
  like mental health issues, suicide, chemical use/abuse or violence in the workplace discussed as part of MSHA or other worker training.
• Why, during typical MSHA training sessions, are the same hard-skill topics delivered and repeated in the same manner year after year? Yet seemingly uncomfortable topics are ignored?
• How might mental health issues contribute to the powered haulage, slips/trips/falls, electrical and other hazards that are repeatedly root causes for fatalities in the mining industry? Why are not connections being made and discussed?
• Why is it so difficult for instructors or trainers to move out of their “comfort zone” to incorporate non-traditional training topics, even if they are not required by MSHA?

Hafeli is an excellent example of someone who uses personal experiences, conducts research and develops the courage to step outside of his “comfort zone” to talk about difficult topics that affect workers. Stepping out of our comfort zone is undoubtedly challenging, especially for instructors and trainers. 

We invest years in educational or training programs to build our knowledge foundation, followed by extensive planning and development of training programs based on our expertise. Venturing beyond our comfort zone can be stressful, but it can also be the initial stride towards creating classes that prioritize introducing new learning experiences to the workforce.²

This article, encouraged by Hafeli’s story, will focus on what are considered two silent killers in the mining industry: suicide and fentanyl use/abuse. Each of these can be an issue by themselves, but oftentimes, they are intertwined. It is hoped the information provided in this article will not only spread Hafeli’s message, but will encourage mining company leaders to do more to assist their workers who struggle with mental health issues, suicidal thoughts and fentanyl or other chemical use and abuse. 

WORK-RELATED QUIET KILLERS

Killer Number One: Death by suicide 
The construction and mining industries face not only familiar hazards and risks but also a deeply concerning issue: a high suicide rate among its workers. According to the CDC, the mining industry has one of the highest suicide rates compared to other sectors. 

In 2016, the suicide rate for men in construction and extraction industries was nearly twice the rate of other occupations, and in 2018, the suicide rate for men in construction and extraction was five times higher than work-related fatalities. More recently, a study conducted in 2020 by Lorek revealed that a staggering 83% of construction workers have experienced mental health issues, with substance abuse and suicidal thoughts being potential consequences. 

This alarming trend highlights the importance of addressing mental health, stress, depression and suicide prevention alongside other safety measures like lockout/tag-out and accident prevention. The predominance of men in the industry, coupled with underreporting and limited access to appropriate treatment, contributes to the heightened vulnerability of construction workers to mental health challenges and self-destructive behaviors. 

This correlation between mental health problems, substance abuse, and suicide underscores the urgent need for comprehensive support and intervention within the construction sector.

Possible leading indicators of death by suicide

• COVID-19.
• Unemployment.
• Job dissatisfaction.
• Housing/financial problems.
• Coworker threats.
• Personal relationships.
• Mental health issues.
• Substance abuse.
• Death of a family member.
• Depression.
• Stress at work/home working long hours.

As noted above, work-related stress in the industry can have severe consequences on mental health, potentially leading to substance abuse and suicide. Factors such as seasonal work, challenging schedules, and workplace injuries treated with opioids contribute to increased risk factors for suicide among miners and are all indicators that management should be aware of throughout the year. 

To illustrate, “Workers in construction face many work-related stressors that may increase their risk factors for suicide, such as the uncertainty of seasonal work, demanding schedules and workplace injuries that are sometimes treated with opioids,” declared Jim Fredrick, acting assistant Secretary of Labor.

How culture impacts mental health and well-being 
While safety education and best practices have significantly improved in the last 25 years, mental health education concerning worker safety has received little to no attention. However, it is crucial to recognize that workers’ mental well-being is just as important as adhering to safety protocols like wearing personal protective equipment, fall protection and seat belts. 

In the construction industry, the mental health of workers may be influenced by a workplace culture that promotes a “macho” image as the norm. The Construction Industry Alliance for Suicide Prevention highlights that many individuals within the industry suffer silently due to cultural expectations. 

Despite progress in education and awareness, mental health issues remain stigmatized, and suicide is a forbidden subject on construction sites. Consequently, workers often feel compelled to cope alone, avoiding the necessary help and allowing their symptoms to worsen. Recognizing and addressing mental health challenges is vital to create a supportive and healthy environment for construction workers.

Some workers may be hesitant to come forward but if a culture of understanding is developed, both at work and home, workers will be more willing to speak up. Providing educational opportunities and increasing worker awareness are ways to help reduce the number of suicides in the mining industries. 

Training leaders and managers to identify signs leading to suicide and empowering workers to seek assistance for mental health issues will help develop a workplace culture that acknowledges suicide is an issue that needs to be addressed. According to Construction Industry Alliance for Suicide Prevention (CIASP), the following are signs of serious anxiety, depression, and suicidal thoughts that can be especially noticeable on construction sites – many of which are directly applicable at mining operations:

Signs of potential mental health issues

• Decreased productivity.
• Increased conflicts with coworkers.
• Near hits, incidents and injuries.
• Decreased problem-solving ability.
• Increased tardiness or absenteeism.
• Mental disorders.
• Extreme mood swings.
• Alcohol or substance abuse.
• Impulsive or aggressive tendencies
• Expressing feelings of hopelessness.
• Major physical health issue.
• Family history.
• Deterioration in personal hygiene.
• Sense of Isolation.
• Discrimination in workplace or off-work.
• Being harassed or bullied at work.
• Loss of job or finances.
• Getting divorced.

Whether one is the company owner, president, a front-line or middle manager, safety director or a front-line worker, it is everyone’s responsibility to keep co-workers safe. Mental health education and suicide prevention are just as important to safety as are the typical topics covered in worker training. Ignoring or treating this topic as taboo will only continue the trend of rising suicides in the construction industries.

Killer Number Two: Fentanyl use, abuse and deaths Workers in the extraction industries have the highest mortality rates from natural and semisynthetic opioid–related overdose deaths and the second highest death rate from synthetic opioid-related overdose deaths, according to a study of occupations associated with drug overdose deaths based on mortality data from the National Occupational Mortality Surveillance System. 

There are currently 267,000 workers in the extraction industry; of these 46,725 (17.5%) have an alcohol abuse problem; 13,350 (0.05%) used illegal drugs and 30,705 (11.5%) suffered from substance abuse addiction. These numbers represent 34% of all workers in the construction and extraction industries.

What does fentanyl do and how is it misused?***
Fentanyl is an extremely potent painkiller, with the CDC stating that it can be up to 100 times stronger than morphine. While it is commonly used in medical settings to manage pain after surgery or for individuals with advanced cancer, its high potency and ability to provide relief and pleasure have led to its illicit use as a street drug. However, the recreational use of fentanyl comes with significant risks, including addiction and overdose.

Pharmaceutical fentanyl is a synthetic opioid, a lab-created compound, used under medical supervision. It can come in a variety of formats including:

• Nasal Spray: To treat cancer pain.
• Injection: For pain during/after surgery.
• Patch for the Skin: For pain after surgery.
• Oral Spray/Tablet/Lozenge: For cancer pain.

Fentanyl travels through the bloodstream and attaches to opioid receptors in the brain, reducing pain sensations. It is commonly used in controlled medical settings and for managing severe cancer pain. Fentanyl also has the potential to induce pleasurable feelings, often described as euphoria. 

However, it can also cause side effects such as drowsiness, nausea, confusion, constipation and addiction. Individuals addicted to fentanyl may experience unpleasant withdrawal symptoms including muscle and bone pain, diarrhea, vomiting, cold flashes and involuntary leg movements.

Regardless of whether it is obtained legally or illegally, using fentanyl incorrectly poses serious risks, especially when taken in excessive amounts, combined with certain medications or used with alcohol. Misuse of fentanyl can lead to loss of consciousness, respiratory issues, and potentially fatal overdose. Indications of an overdose include a weak pulse, slow or irregular breathing, small pupils and blue/gray edges around the mouth.

Although a legally manufactured opioid in the United States, it can be obtained through theft, fraudulent prescriptions or illegal labs. Illicitly produced fentanyl is often sold in various forms such as powder, nasal spray, or counterfeit pills resembling other prescription opioids. There are more than 30 non-pharmaceutical grade fentanyl-like drugs circulating on the illicit drug market, many of which cannot be detected by standard urine drug screens. 

Illicit fentanyl can be used in ways similar to prescribed fentanyl, but it is frequently misused by snorting or smoking. Some individuals who misuse fentanyl extract the gel contents from patches and either inject or ingest them. Freezing patches and placing frozen pieces under the tongue is another method used. Furthermore, certain individuals turn to carfentanil, an ultrapotent fentanyl analog used legally to sedate large animals. It is crucial to note that misusing fentanyl in these ways is not only dangerous but also potentially deadly.

Due to its high potency, the Drug Enforcement Administration (DEA) warns that even a tiny dose of just 2 mg of fentanyl can be lethal. Opioids with high potency like fentanyl, oxycodone, methadone, and methadone HCl carry more significant risks.

Synthetic opioids like fentanyl are the most common drugs involved in overdose deaths. Between 2020 to 2021, 80,000 Americans died of problems related to synthetic opioids and unfortunately, the death toll continues to rise dramatically:

• The number of synthetic opioid overdose deaths increased 97-fold from 1999 to 2021.
• Overdose deaths involving synthetic opioids in 2020 were 18 times the number in 2013.

Efforts to prevent fentanyl overdoses
To help reduce the risk of fentanyl abuse, addiction and overdose, the Food and Drug Administration (FDA) requires fentanyl prescriptions to be closely monitored to ensure the benefits outweigh the risks. It is covered under the Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) to educate health care providers on treating and monitoring patients with pain. Transmucosal immediate-release fentanyl (TIRF) is a restricted distribution program to help ensure people use TIRF safely. 

TIRF medicines are for people with cancer who have been prescribed other, continuous opioids for their pain and need additional measures for breakthrough pain. To help ensure TIRF is distributed only to people who are opioid tolerant, TIRF Risk Evaluation and Mitigation Strategy includes requirements such as:

Risk evaluation and mitigation strategy

• Prescribers must document a person’s opioid tolerance.
• Pharmacies must document and verify a person’s opioid tolerance before releasing TIRF.
• A patient registry is kept to monitor for misuse, abuse, addiction and overdose.

Discussion of these topics in MSHA and other worker training events will help raise awareness about them. This article was written to encourage company owners and managers in the construction industries to begin talking about suicide and fentanyl use/abuse with their workers rather than looking the other way and pretending they are not issues which affect them. It is only by having these discussions and creating a supportive and healthy environment for construction workers will this disturbing trend be reversed.

Joseph McGuire, Ph.D. is an independent safety and health consultant ([email protected]), and Lucas Simpson, Area Safety Manager for Commonwealth Electric ([email protected]).