Buprenorphine, an FDA-approved medication for opioid use disorder, or OUD, has been shown to prevent overdoses. It may also improve OUD patients’ employment prospects. A new report from the New England Public Policy Center at the Federal Reserve Bank of Boston finds that OUD patients treated with buprenorphine experience increased job-finding rates, especially in the period shortly after they start taking the medication. 

“These results, while modest in magnitude, suggest that the same treatment protocol already shown to prevent overdoses and save lives also holds promise for helping OUD patients return to work,” the report’s authors write.

The report’s finding could have implications for mitigating the economic fallout from the opioid crisis, especially now, when New England and the country as a whole are experiencing labor shortages.

The report is titled “Can Treatment with Medications for Opioid Use Disorder Improve Employment Prospects? Evidence from Rhode Island Medicaid Enrollees.” It was written by Boston Fed senior economist and policy advisor Mary A. Burke along with senior policy analyst Riley Sullivan. The report is based on research that Burke, Sullivan, and others conducted for a Boston Fed working paper titled “Employment Trajectories among Individuals with Opioid Use Disorder: Can Evidence-based Treatment Improve Outcomes?”

The report focuses on Medicaid enrollees in Rhode Island, the state that had the 10th highest age-adjusted opioid-related mortality rate in the United States in 2020. It uses the Rhode Island Data Ecosystem, a data set that links payroll employment records with information from the medical and pharmacy claims of Medicaid enrollees in the state.

The authors note that Rhode Island’s Medicaid population in 2018 accounted for nearly 62% of the state’s total opioid-related deaths in that year. “Because the data capture a population that has elevated rates of opioid use disorder along with below-average employment rates, this population represents a suitable group for identifying potential opportunities to improve both health outcomes and economic outcomes,” they write.

Data indicate that that OUD is negatively associated with employment

The report also finds that individuals diagnosed with OUD are less likely to be employed compared with other Medicaid enrollees, that their employment tends to be more intermittent, and that they faced increased risk of job separation after receiving their initial diagnosis. The authors note that the findings related to job separation risk, which control for numerous other factors that also might affect the chances of losing a job, suggest that OUD itself may play a role in reducing a person’s chances of staying employed.

However, they caution that the associations they observe are not necessarily causal. For example, they write, other adverse events may occur around the same time that a person receives an OUD diagnosis that might also increase their chances of leaving a job (whether voluntarily or otherwise). Similarly, the relationship between starting buprenorphine and an increased likelihood of finding a job may arise because a person’s life circumstances are improving at the same time they start taking buprenorphine to treat OUD.

Methadone treatment is not associated with job-finding benefits

The report finds that treatment with methadone is not associated with a significant increase in the job-finding rate among OUD patients. The authors say that one potential explanation for this result is that individuals treated with methadone tend to have more severe OUD on average compared with those treated with buprenorphine, and therefore they may be less capable of finding employment even after starting treatment.

Past research suggests that aside from having more severe cases of OUD, methadone recipients may disproportionately face a variety of additional barriers to employment, such as housing insecurity. Also, most methadone patients must visit a specialty treatment facility daily to receive their medication. OUD patients being treated with buprenorphine can get a prescription for the medication and take it at home.

“Although this result might seem disappointing, it does not mean that policy should discourage the use of methadone to treat OUD,” the authors write. “Evidence shows that methadone is highly effective and should be preferred over buprenorphine for some patients.”

They add that medical providers might want to consider whether someone is seeking employment when deciding which of the two treatments to recommend, especially if either medication would prove equally effective for the patient.

Opioid deaths at record high amid widespread labor shortages

The report notes that the opioid crisis intensified during the COVID-19 pandemic. Opioid-related deaths nationwide rose to nearly 81,000 in 2021, an increase of more than 60% compared with the number for 2019. Meanwhile, the U.S. labor force participation rate fell sharply due to the pandemic and has yet to fully recover. As of September 2022, that rate remained 1 percentage point below its February 2020 level, despite record numbers of job openings in 2021 and 2022.

“If increased rates of OUD are, in fact, holding back growth in labor force participation and/or employment, the consequences could include added fiscal burdens at both the state and federal levels in the form of lower payroll taxes and increased reliance on public assistance programs,” the authors write.

They note that this issue should be of particular concern in New England, where opioid-related deaths have exceeded the national average since 2000.

“The unfortunate confluence of labor shortages and record-setting opioid mortality in the current environment highlights the need to better understand the relationship between opioid use and employment and prompts the question of whether effective medications for opioid use disorder, which have been shown to save lives, might also help to bolster the employment prospects of OUD patients and reduce the economic burden of OUD on society,” the authors write.

Pandemic-related policy innovations could lead to greater uptake of OUD medications

The report suggests that receiving medications alone may not be enough to guarantee employment for a person with OUD.

They note that the Americans with Disabilities Act requires employers to offer “reasonable accommodation” for employees with substance use disorders to comply with treatment programs. But research finds that such compliance has been incomplete in practice.

The report says that Rhode Island has been a pioneer in tackling the opioid crisis, noting that it has taken advantage of policies introduced during the COVID-19 pandemic that allow a greater number of patients to receive take-home doses of methadone. The state also saw the launch of the country’s first mobile methadone unit. In addition, Rhode Island was the first state to offer streamlined authorization for medical students to prescribe buprenorphine.

“Given these encouraging recent policy innovations and our results suggesting that taking medications for OUD can help patients return to work faster and possibly to increase their earnings,” the authors write, “there is room for optimism despite the daily drumbeat of bad news related to the opioid crisis.”

Read the report.