Last year, as a construction apprentice learning to install insulation and remove asbestos, Michael Rossi injured his knee. After telling his coworkers he would be out for a few weeks for surgery, one man pulled him aside.
"He said, 'You're an apprentice, you need the money, why not go to a doctor and get something and mask the pain,'" Rossi recalled. "And I had to tell him, that's not really an option for me. I was coming up on five years of sobriety. I'd struggled with painkillers. The last thing I wanted to do was get a script for them."
Rossi had just gotten a lesson in a hidden reality of the construction industry: In these physically demanding workplaces, painkillers are still a common way to get through the day, even as the opioid crisis has spiraled and workers have attended funeral after funeral. Workplace data on addiction is sparse, but recent research has indicated that construction workers are at higher risk for fatal overdoses — particularly heroin overdoses.
Rossi couldn't stop thinking about the conversation. At home, recovering from surgery, he called the president of his union. "I'd already seen a lot of guys in the trades who ended up dying or getting thrown out of the apprenticeship program," he said. "And so I asked him what we were doing about the opioids."
These days, Rossi is a peer advocate, one of a few dozen construction workers in Philadelphia's building trades who double as recovery aides on job sites around the city. They watch for coworkers who might be showing the signs of a substance use disorder and encourage them to seek treatment. Or they help colleagues in recovery stay sober on the job site.
"I never thought I'd be breaking my anonymity," said Rossi, who participates in a 12-step recovery program. "But I feel compelled to now."
The peer advocates are all volunteers, trained by the Allied Trades Assistance Program, the building trades' program that refers members and their families to substance-use treatment. ATAP has been around for 30 years, but its peer advocates program is just a year old, spearheaded by executive director Ken Serviss.
Advocates say they work to dispel the stigma against addiction on the job site by being as open as they can about their lives, hoping that coworkers will come forward.
"If you're working in the room with me, you know what I had for breakfast, I'm going to tell you about my kids, and I'm going to tell you about my peer advocacy," said Ed O'Toole, a plumber. "I tell the general contractor on the job, if there's anyone struggling, let me know, before they lose their job."
Serviss is hoping to expand the peer advocate program by applying for federal grants, recruiting more members and training advocates to dispense Narcan, the overdose-reversing spray, on job sites.
Advocates, who meet every month at ATAP's headquarters in the Far Northeast, are split between older union members, who largely have dealt with alcoholism, and a younger group more familiar with painkillers and heroin addiction.
One advocate was homeless for 15 years before entering recovery and getting a job as a laborer; another, sober for decades, is now trying to help his son through an opioid addiction as he counsels coworkers on job sites.
Others came to the program after losing coworkers to overdoses: "We had a young man on one job, and he was messing with heroin, and they fired him, and within a year he was dead," said John "Mac" McFadden, a painter. "I'm just not quiet about being sober anymore. Now that I'm a peer I make sure everyone knows who I was and what I'm about. We've got ATAP stickers on the damn hard hats now."
The nature of the industry, Serviss said, presents unique challenges for construction workers entering recovery. A tradition of drinking and substance use among some in the trades can make it difficult for newly sober workers to feel comfortable with people they used to party with after work. "Work hard, play hard," said Michael Pollack, a laborer in recovery from heroin addiction, "except then you start playing at work."
Stigma against medication-assisted treatment, considered the gold standard for treating opioid addiction, is even stronger in an industry where drug testing is frequent and employers are worried about liability.
The treatment medications methadone and suboxone, both shown to help produce far more lasting recovery than abstinence alone, are themselves opioids, but used at doses that stave off cravings without producing a high. Still, Serviss said, if they are found on a drug test, it's grounds for getting kicked off a job site. Some of his advocates who got sober in abstinence-only programs are wary of opioid-based treatments, thinking they could be misused. "When I'm up on a swing," a painter said at a recent meeting, "I don't want no one on suboxone next to me."
"Do we work on changing some of those policies to help people, or do we continue down the same road?" Serviss asked. "The stigma around [medication-assisted treatment] is the most difficult component. To change that mindset is very difficult."
Still, he said, as the opioid crisis has deepened, he sees union leadership paying closer attention. At union meetings, he said, leaders are pointing out peer advocates, encouraging their workers to reach out to them, speaking about the building trades' options for substance abuse treatments.
"I think we're having a lot more success in penetrating our leadership," he said, "because everyone's going to a funeral."