Employment Trajectories among Individuals with Opioid Use Disorder: Can Evidence-Based Treatment Improve Outcomes? 
The current confluence of labor shortages and record-setting opioid mortality highlights the need to better understand the relationship between opioid use and employment. In addition, it prompts the question of whether effective treatments for opioid use disorder (OUD) might not only save lives but also improve the employment prospects of OUD patients. Using administrative records of Medicaid enrollees in Rhode Island that link their health-care information with their payroll employment records and other data sources, this paper produces new stylized facts concerning the association between OUD and employment and inquires as to whether treatment with FDA-approved medications boosts the job-finding rates of OUD patients.
Key Findings
- Individuals diagnosed with opioid use disorder (OUD) are less likely to be employed compared with other Medicaid enrollees, and their employment tends to be more intermittent. Among those observed both before and after receiving an OUD diagnosis, the likelihood of being employed was significantly lower in the period after the first diagnosis date, and among the employed, the risk of job separation was significantly higher after diagnosis. The latter results suggest that OUD itself may reduce an individual’s capacity to maintain employment, but other explanations cannot be ruled out.
- Based on a cross-sectional comparison, OUD patients who received medications for their condition (either buprenorphine or methadone) were more likely to have been employed (as of 2018) and had higher earnings on average (in 2018) than OUD patients who never received such medications.
- Based on a regression analysis that controls for numerous confounding factors, commencing treatment with buprenorphine is associated with an increased job-finding rate among nonemployed individuals with OUD. However, the potential benefits of buprenorphine for job-finding rates appear to be concentrated in the period shortly after a person first starts taking the medication.
- On average, among eventual methadone recipients, starting methadone treatment is not associated with any significant increase in the job-finding rate. The contrasting results for buprenorphine versus methadone point to the fact that patients treated with methadone tend to have more severe opioid use disorders and may face additional barriers to employment compared with those treated with buprenorphine.
- The earnings of OUD patients increased more for those who initiated either methadone or buprenorphine and then became reemployed as compared with those who resumed employment without having initiated either medication.
Implications
The paper’s findings suggest that individuals with OUD may find it harder to maintain employment. Undergoing treatment with medications, especially buprenorphine, might help improve their employment prospects, but additional supports may be necessary. More work should be done to help employers facilitate treatment and support patients in recovery from OUD, such as by allowing employees to take time from work (or adjust their schedules) to receive in-person treatments for OUD. 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 in practice compliance may be constrained. In addition, states could take advantage of policies introduced during the COVID-19 pandemic that allow for a greater number of patients to receive take-home doses of methadone. Such policies might reduce the potential incompatibility between receiving treatment for OUD and retaining a job. Research finds that these policies have been largely successful where they have been implemented and that they have not led to significant increases in illegal diversion of the medication.
Abstract
Using administrative records of Medicaid enrollees in Rhode Island that link their health-care information with their payroll employment records, this paper produces new stylized facts concerning the association between opioid use disorder (OUD) and employment and inquires as to whether treatment with FDA-approved medications might boost the job-finding rates of OUD patients. We find 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 face increased job-separation risk following their initial diagnosis. In addition, commencing treatment with buprenorphine is associated with an increased job-finding rate among nonemployed OUD patients, while commencing methadone treatment is not associated with any significant change in job-finding rates. The job-separation rate and job-finding rate results are based on Cox proportional hazard regressions that control for numerous potential confounding factors. The paper discusses a variety of causal and noncausal explanations for these results in addition to their potential policy implications.