Fatal drug overdoses and suicides among U.S. construction workers declined in 2024, marking a notable shift in a sector long plagued by disproportionately high behavioral health risks.
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New data released by North America’s Building Trades Unions and CPWR — The Center for Construction Research and Training shows that drug-related overdose deaths among construction workers aged 16 to 64 fell 28.8% from 2023 to 2024 — representing approximately 4,600 lives.
The overdose fatality rate dropped from 135.0 to 94.8 per 100,000 workers. For comparison, the industry’s on-the-job fatality rate in 2023 stood at 9.6 deaths per 100,000 workers, meaning overdose deaths were still more than 10 times higher than jobsite injury fatalities that year.
Updated 2024 workplace fatality data from the Bureau of Labor Statistics is scheduled for release Feb. 19.
According to CPWR and NABTU, several key developments likely contributed to the steep reduction in overdose deaths:
Over the past several years, unions, contractors and industry associations have intensified efforts to address substance misuse — particularly given the physically demanding nature of construction work, which historically led to higher rates of opioid prescriptions following injury.
Safety leaders say the integration of harm-reduction strategies, including naloxone access and peer support programs, is becoming more common on major projects. Some contractors now treat overdose prevention as part of standard safety protocols, similar to fall protection or confined space training.
The decline in deaths by suicide was more modest but still significant. Suicide fatalities fell 1.7% year over year, with the rate decreasing from 43.2 to 41.9 per 100,000 workers.
Even with that improvement, suicide deaths remain more than four times higher than jobsite injury fatalities in the sector.
CPWR continues to promote its suicide prevention toolbox talk — available in English and Spanish — as part of broader awareness campaigns. The organization also points to upstream interventions, including:
Mental health advocates emphasize that suicide prevention requires both crisis intervention and structural change, particularly in a workforce facing long hours, transient employment and economic uncertainty.
In recent years, contractors have increasingly acknowledged the mental health crisis affecting the workforce.
In 2023, Reston, Virginia-based Bechtel pledged $7 million over five years to the American Foundation for Suicide Prevention — the largest donation in the nonprofit’s history.
Last summer, Bechtel introduced “Hard Hat Courage,” a branding campaign paired with a suicide prevention toolkit developed in partnership with AFSP and a CEO advisory council. The initiative aims to equip contractors of all sizes with tailored mental health education and prevention resources.
Other firms have followed suit. Sweden-based Skanska has implemented jobsite programs spotlighting workers trained in mental health support — building on practices the company piloted in the U.K.
Meanwhile, Chicago-based Clayco conducted surveys over two years to better understand worker concerns and barriers to speaking up about mental health struggles.
As a result of that outreach, Clayco expanded on-site mental health support and encouraged participation in psychological safety training.
Dan Lester, vice president of field culture and inclusion at Clayco, underscored the importance of leadership modeling openness.
“One thing that all leaders need to do is model vulnerability,” Lester said. “If you’re vulnerable first, if you talk about how things are challenging to you, it gives people the license or the green light to say, ‘Oh, my leader is talking about it. They took a mental health day. It must be okay for me to take a mental health day.’”
While the numbers remain high relative to other industries, experts say the downward trend signals progress in tackling long-standing stigma around mental health and substance use in construction.
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Historically, workers faced pressure to “tough it out,” with limited discussion of stress, depression or addiction. Today, mental health standdowns, toolbox talks and peer-support programs are increasingly common across union and nonunion environments alike.
Industry observers caution that sustaining the decline will require continued investment in prevention, access to affordable care, and policies that reduce chronic pain and jobsite injury — factors closely linked to substance misuse.
For workers in crisis, the 988 Suicide & Crisis Lifeline remains available nationwide.
Originally reported by Zachary Phillips, Editor in Construction Dive.
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