OSHA wants overdose reversal medication treated like the first aid kit. On Sept. 24 the agency released a fact sheet, “Opioid Overdose Rescue with Reversal Medications” (OSHA 4519), telling employers to keep FDA-approved naloxone or nalmefene on hand, store it where people can find it, and train workers to use it.
It’s guidance, not a standard. Nothing in the OSHA naloxone fact sheet creates a new citation hook, and it doesn’t reference any existing first aid rule. But for construction, it lands in the industry with the worst numbers.
Why the OSHA naloxone fact sheet matters on jobsites
CDC data for 2020 put the age-adjusted drug overdose death rate for construction and extraction occupations at 162.6 per 100,000 workers. The rate for all workers was 42.1. No other occupation group came close. Food preparation and serving was second at 117.9. Those figures, published in a 2022 CDC MMWR QuickStats covering 46 states and New York City, are six years old, but nobody in the trades expects the ranking has flipped.
OSHA’s own release doesn’t single out construction. It’s written for all workplaces and was developed with CDC, HHS and other agencies.
What the naloxone guidance asks employers to do
The recommendations are practical and short:
- Keep reversal medication in visible, easy-to-reach spots, such as next to AEDs and first aid kits.
- Put one person in charge of supply and expiration dates.
- Train workers on the signs of an overdose (slow or stopped breathing, blue lips or skin, pinpoint pupils, unresponsiveness), how to give the dose, how to place someone in the recovery position, and what withdrawal symptoms can follow.
- Cover state Good Samaritan protections and how to connect someone to treatment afterward.
- Call 911 every time. Reversal drugs wear off, and more than one dose may be needed.
The fact sheet also lists ways to buy it: over-the-counter nasal sprays at pharmacies, wholesale distributors, state standing orders, group purchasing organizations, manufacturer programs and public health departments.
Where overdose response gets hard in construction
Storage is the first problem. The fact sheet says to follow label conditions, keep the medication away from direct light and excessive heat, and not let it freeze. A job trailer in Phoenix in August or a gang box in Minneapolis in January fails both tests. Contractors will need a plan for where kits live on sites without a climate-controlled office, and whether foremen carry them.
Training is the second. Crews turn over, subs rotate through, and the person who knows where the kit is may be three floors away. That’s why some of the more serious programs pair naloxone with site orientation and with the mental health and substance-use content New York City has now written into its Site Safety Training card requirements. Response after the event matters as much, a point Exchange covered in its look at the first 48 hours after a jobsite death.
The OSHA 4519 fact sheet is two pages. The rate it’s up against is nearly four times the all-worker average.