We will recruit three health funds to implement the opioid guidelines. Participating health funds will receive an introduction to the intervention materials and will discuss guideline adoption procedures with the research team. In order to implement the workplace opioid guidelines (intervention), each participating health fund must agree to make changes to their health fund policies and to engage employers to change some of the workplace policies. In order to evaluate the guideline implementation, the health funds must participate in baseline, 6, and 12 month interviews to describe changes in their opioid policies and programs, distribute a survey link to their members, and provide access to their health claims, pharmacy data, and employee work hour records. Participating health funds will be asked to sign a partnership agreement form, as we have done in our past intervention studies with construction partners, to show their understanding of the project and their agreement to participate in all study activities and to provide data over the course of the implementation trial.

We will use the RE-AIM framework to assess the Reach, Adoption, Implementation, and Maintenance of the intervention in each participating health fund. Reach will assess workers' awareness of policies and benefits, Adoption will identify the new policies agreed to by the board of trustees for each health fund, Implementation will describe the strategies for enacting the adopted policies and programs, and the extent these strategies are implemented, and Maintenance will identify the continued delivery of implemented policies and programs. Adoption, Implementation, and Maintenance will be assessed via periodic interviews with the health fund partners. Collection of health fund data on claims and work hours will show the feasibility of obtaining and using these data to evaluate effectiveness in the planned future study. Use of the RE-AIM framework will provide an evaluation of the extent to which the opioid guidelines are implemented, and describe barriers to implementation.

Data collection for the outcome measures will include worker surveys and health claims from the enrolled union health funds. We will analyze the data by measuring the pre-post change in the outcome measures. Participating health funds will provide access to construction workers to collect a cross-sectional sample of surveys at three points in time. We will ask our partners to distribute a link for a Redcap survey to a representative sample of their members (eligible workers) with a goal of at least 300 returned surveys per health fund at baseline. We will collect an additional 300 surveys at 6 months (and at 12 months if time allows) from each fund after initiating the intervention. We will attempt to oversample women and minorities, as they are less common in this worker population. The brief survey will ask about workers' knowledge of their health fund's benefits and policies, attitudes toward use of opioids by self and others, employment status, participation in union programs including EAP, and health-related productivity using widely used survey instruments. We will work with participating funds to obtain health claims and pharmacy data for all eligible union members for a period of at least 3 years prior to implementation of the intervention. From health claims, we will request data for demographics, dates of service, and diagnoses and procedure codes. From pharmacy data we will request the dates of prescription fill, drug name, days' supply, and fill quantity. From merged claims and pharmacy data we will identify relevant opioid use case definitions: workers who received opioid prescriptions, workers who misused opioids (defined as multiple prescriptions of opioids in a single visit, overlapping supply of opioids, early refills), workers who received chronic opioid prescriptions (classified as 60 day supply in a 90 day period), and workers with OUD (defined as a diagnostic code of F11, poisoning T40, or prescription for MAT). We will also work with the funds to obtain employee work hour records. Using the same unique identifier as the health claims data, we will link claims and pharmacy data to the weekly or monthly work hour logs, union eligibility status (active/retired/other), and employer. We will examine loss of employment or average work hours for those who remain employed among workers who meet or do not meet one of the opioid use case definitions. We will collect other administrative data including the number of visits to the employee assistance program (EAP), the number of workers who enrolled in recovery centers, and those filing for disability benefits to compare utilization of services by workers before and after the intervention.

We will measure the change from baseline (pre-) to 6 months (post-) and 12 months (post- if time allows). The outcome measures will be from claims data (pre-post change in opioid misuse, chronic opioid use, and opioid use disorders) and from surveys (opioid misuse, lost time due to pain, and worker willingness to seek help). For claims data, we will compare the prevalence of the outcomes from 3-year period prior to the intervention compared to the 6-months after start of the intervention (collected at 6-months). For survey data, we will compare the prevalence of the outcomes from cross-sectional data collected at baseline to cross-sectional data collected at 6-months after start of the intervention. We will collect surveys from 300 members of the population, representative of the characteristics of the population, at baseline and at 6-months (and 12months if time allows).

To learn about changes each participating health fund makes to their health and safety program from using the Opioid Guidelines, we will interview the health administrator at baseline, before starting the intervention, will meet monthly with the administrator to learn about changes to their program, and conduct a final assessment. We will explore what plans the health fund wants to make to reduce opioid abuse among their members, the steps they take toward implementing changes including their strategies and response to their actions. We will also document the barriers encountered while trying to make plans and take action for change.