After the Addiction, Opioid Users Struggle to Get Back to Work

Given the nationwide opioid epidemic, John said he didn’t think disclosing his methadone treatment for a previous opioid addiction to his employer would be a big deal.

The clinic where he received treatment six times a week was only four or five miles from the restaurant where he worked, but the trip via public transportation often took two hours. So, he asked for an accommodation as he could be late if his appointment took longer than usual.

His boss was initially understanding. “Next thing I know, the switch flips,” he said in a phone interview—his identity concealed behind a pseudonym so as to not undermine his search for a new job.

John suddenly felt as if he was working under a microscope. His boss, who’d previously praised him for his speed, started to complain he wasn’t fast enough.

It seemed “he was trying to say I was high at work,” John said. He was soon fired for what he asserts were purely pretextual reasons and has since sued his former employer under the Americans with Disabilities Act.

His situation is not unique. Millions of Americans are afflicted by Opioid Use Disorder, according to the US Centers for Disease Control and Prevention, which estimated more than 80,000 opioid overdose deaths last year. Still more people have struggled to break their addictions and return to productive lives, only to discover their condition now poses its own obstacle.

The Equal Employment Opportunity Commission and Department of Justice have both issued guidance in recent years reiterating that the ADA prohibits discrimination against individuals in recovery from OUD, who are not engaging in illegal drug use. That includes those receiving legally-prescribed methadone or a similar medication-assisted treatment.

But workers like John, their lawyers, and employer-side attorneys all say confusion and stigma surrounding such medication-assisted treatment, or MAT, persists.

“If we’re gonna keep a reformed addict from being able to work even in a restaurant, what places are there?” said Peter Hall Steckel, a plaintiff-side employment attorney in Georgia.

The EEOC said it’s received more than 200 ADA charges involving opioid issues since 2019, and, since publishing their guidance, the agencies combined have recovered at least $520,000 in damages and backpay for employees and applicants who said they were discriminated against due to their treatment.

Methadone Treatment Increases

More than a half-million patients received MAT in 2021, an increase of more than 150,000 from 2020, according to a report released by the American Association for the Treatment of Opioid Dependence. And more than 93% of those patients used methadone.

AATOD President Mark Parrino said he expects the number of patients receiving MAT to continue to grow “because there’s no sign that this opioid epidemic is abating.”

There are now more than 2,000 opioid treatment programs in the US that are able to administer drugs to assist in weaning people with addictions from legal and illegal pain killers, and the number of clinics may increase as states and municipalities start to disburse $54 billion in opioid crisis litigation settlements.

Ongoing Medical Debates, Stigma

There are groups in the treatment field who feel medications like methadone are “a crutch,” or that those receiving MAT are “not in true recovery,” said Parrino, who’s worked in that field for 40 years.

To “indicate that the use of medication is not going to be helpful is not based on reality, or what we’ve learned over 50 years,” he added.

Such stigma extends to individuals outside of the treatment community too.

Parrino said it’s evident at congressional hearings where representatives don’t understand the potential need for long-term methadone maintenance, and in communities where once unfriendly neighbors “suddenly engage” with one another to prevent the opening of a new methadone treatment program.

Employers Struggle to Draw the Line

Ten to 15 years ago, attorneys were “somewhat confident that somebody who is currently in treatment was not protected by the ADA,” said Fiona Ong, a partner at employer-side firm Shawe Rosenthal LLP.

“That’s very different than now” because of EEOC and DOJ guidance, she said, adding “Now, you do have to accommodate, but what does that mean, right?”

Still, when it comes to considering job applicants and opioid use, “I think it’s super easy for employers to just rubber stamp like, we’re not even going to go near that, we don’t even want to have to deal with it,” said Anne Hunter, an employee-side attorney in Tennessee.

“It’s really a process of also educating the employer that they’re not medical professionals,” Ong said. “They can’t make those judgments.”

Those who employ workers in safety sensitive positions, including those handling dangerous equipment, are really struggling with how to determine if their employees are impaired, she said.

Ong said she encourages those employers to work with an employee’s doctor to determine whether or not their medication-assisted treatment can have an adverse impact on their ability to perform their jobs efficiently and safely.

Fred J. Bissinger, an employer-side partner at FordHarrison LLP, understands such concerns.

“If they do something stupid around machinery, they can lose a finger, a hand, an arm, or they can die,” he said. He tells his clients to receive medical input as well, and to set very clear behavioral expectations so managers know what to look for in terms of intoxication.

Parrino acknowledged that there’s an active and open debate about methadone’s potential interference with an individual’s motor functions and ability to work.

“Maybe during the first few weeks of treatment, as dosages are being titrated upward, the patient may experience some moments, some days, where they are not clear in their thinking. But once the patient is stabilized, there is no fuzzy headedness,” he said. “It doesn’t interfere with motor functions in any way.”

But with many employers facing staffing shortages, Bissinger said employers are generally being more open to working with employees receiving MAT or who have previous addictions.

Employers need to be proactive in preparing for opioid and methadone related issues, he said. If they’re not prepared, they’re “more likely to make a mistake, which creates all kinds of problems.”

More Education Needed

Parrino said he’s asked the federal government to do a broad national education campaign on not just OUD, but methadone treatment, for the last 15 years “because they’re the only ones that have the money to do it. And they’ve just been resistant,” he said.

The Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health & Human Services, “doesn’t disagree that more people need to know about treatment in general period, as well as the medications that are devoted to it,” spokesperson Christopher Garrett told Bloomberg Law. SAMHSA doesn’t currently have any plans to conduct a national education campaign on OUD and treatments like methadone, but has invested in other ways, including $1.6 billion in community grants to combat the opioid crisis and a national training and clinical mentoring project,he said.

“Unless we’re going to be willing to write people off forever because they’ve had this issue, then we’ve got to, as the law has acknowledged, offer some protection,” Steckel said. “And I expect we’ll see more and more of this.”