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Working While in Medication-Assisted Treatment: Protections & Battling Stigma

April 18, 2022

Table of Contents

Your right to Medication-Assisted Treatment (MAT) is protected by federal (and sometimes state) laws. You can't lose a job you have, or an opportunity for a job you want due to MAT.  

We know that Medication-Assisted Treatment is medically essential for patients with OUD and that it is safe, and in fact very important, for patients to continue to work while on MAT. This is why it is illegal for an individual to be denied employment or terminated because they are on MAT. 

With therapy, you'll be able to focus more closely on your work without the disruption an ongoing substance use disorder can cause. 

In spite of these legal protections, many employees face bias and challenges to continue their therapy while working. This article’s purpose is to address some of the frequent challenges and questions that come up for workers who are on MAT. 

Do You Have to Tell Your Employer About Your Use of MAT?

The short answer is no. Legally, under HIPAA law,  you have a right to privacy of your medical conditions and are not legally obligated to disclose your medical history, including your substance use history or your use of MAT. However, as discussed further below, there may be advantages to you choosing voluntarily to disclose use of these medications to your employer. For example, you may need special work hours to accommodate attendance at a daily methadone clinic, or you may need time off to attend a monthly doctor’s appointment for a Suboxone prescription. You may need to disclose to your employer your use of Methadone or Suboxone if your job involves operating machinery, driving, or anything else where oversedation might put you or others at risk. Thus, it may be wise to disclose your use of these medications to your employer so that they can help you be safe and successful in your place of work. 

Will MAT Show Up On a Drug Test?

It depends. Methadone is an opioid and will show up on a drug test. Suboxone, the generic of which is called buprenorphine, is a special test that is not usually included in a standard drug test panel. However, there is a separate test for buprenorphine that may be included in some drug panels and therefore it is possible that your buprenorphine test would be positive if included in the drug screen. Many employers test current and future employees for illicit alcohol and drug use and are in fact permitted to do so legally.[1] 

However, if the drug test is positive for suboxone or methadone and the individual is a known participant in a methadone program or is receiving a legal prescription for suboxone, employers are NOT permitted to discriminate against their employees for use of these two medications. The employer may request proof from the employee that they are enrolled in a qualified methadone program or may require documentation that they are receiving Suboxone from a provider. 

MAT & Your Current Job: Here’s What to Know

The Americans with Disabilities Act protects you during your MAT. But you must take several important steps to ensure you get the protections you're legally entitled to. The ADA offers protections for people who:[2]

  • Have a substance use disorder (SUD)
  • Are undergoing treatment for a SUD
  • Use MAT under the guidance of a doctor and have a prescription to prove it
  • Take MAT as described
  • Do not take other drugs

The ADA applies to companies with a staff of 15 or more people.[3] If you work for a smaller private company, ADA rules may not protect you.

Some states have protections for employers with a staff member total that is smaller than 15 people.[4] But not all do. If you have questions about working for a smaller company and your rights under ADA, you may have to look into the specific policies in your state. 

If you are protected by the ADA, you can't lose your job due to MAT. You can also ask your employer for reasonable changes/accommodations to your work  schedule. But your employer may contest your work or schedule changes. 

For example, your employer might suggest that Medication-Assisted Treatment puts the safety of others at risk. If you work with explosives, machinery, or delicate systems, your employer may believe your MAT could jeopardize your ability to do the tasks necessary for your job. your reflexes and make your work unsafe. 

In a situation like this, your doctor can ask you to undergo additional medicals test.[5]  Work with your doctor and employer to help determine the best plan to keep you employed while still ensuring that you can complete your job tasks safely. 

3 Tips for Current Employees

If you're using MAT, disclosure is optional but may be recommended for the reasons discussed above. Your employer should know that you're using MAT as directed by a doctor. But how should you get started?

Follow these three tips:

  1. Disclose early. Don't wait until you fail your first drug screening test. 
  2. Get your doctor's help. Be ready with a formal, written prescription and/or documentation from your doctor. Ask your doctor for a letter (on letterhead) that explains thatMAT will not affect your work or your job performance. 
  3. Follow the rules. If your employer asks for testing or documentation, do your best to comply and cooperate. This reinforces confidence from your employer. At the same time, do not be afraid to stand up for your right to work while on MAT. 

A good employer should want you to be healthy and and safe at work. If MAT is part of what is keeping you healthy and safe, a good employer should help ensure that you can access MAT while working. If not, your doctor can step in to advocate for you. 

Applying For A New Job While on MAT 

The ADA protects you from the moment you submit an application for a new job. Your Medication-Assisted Treatment should not keep you from getting the job you want, as long as you understand the rules. 

Know your rights when it comes to these things:

  • Interviews: Your future employer cannot ask you medical questions.[6] You don't have to talk about your addiction or your MAT at all, although you may chose to do so voluntarily, particularly if you foresee needing certain accommodations to work while on MAT. 
  • Testing: Your employer can and might test you for illicit drugs.[7] If you are tested, bring your prescription to explain why you may test positive. 
  • Offers: Your employer cannot ask you to stop MAT use as a condition of future employment. This is illegal. 

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. 1. Nearly 8 in 10 Employers Screen for Alcohol, Drugs. Society for Human Resources Management. https://www.shrm.org/resourcesandtools/hr-topics/risk-management/pages/employers-screen-alcohol-drugs.aspx. May 2013. Accessed April 2022. 
  2. Sharing the Dream: Is the ADA Accommodating All? U.S. Commission on Civil Rights. https://www.usccr.gov/files/pubs/ada/ch4.htm. Accessed April 2022. 
  3. Accommodating Workers with a History of Substance Abuse. Society for Human Resources Management. https://www.shrm.org/resourcesandtools/legal-and-compliance/state-and-local-updates/pages/accommodating-workers-with-a-history-of-substance-abuse.aspx. July 2017. Accessed April 2022. 
  4. The ADA, Addiction, Recovery, and Employment. ADA National Network. https://adata.org/factsheet/ada-addiction-recovery-and-employment. 2020. Accessed April 2022. 
  5. Use of Codeine, Oxycodone, and Other Opioids: Information for Employees. U.S. Equal Employment Opportunity Commission. https://www.eeoc.gov/laws/guidance/use-codeine-oxycodone-and-other-opioids-information-employees. April 2020. Accessed April 2022. 
  6. Workers Taking Suboxone, Methadone Protected by ADA, Feds Caution. HR Dive. https://www.hrdive.com/news/workers-taking-suboxone-methadone-protected-by-ada-feds-caution/589660/. November 2020. Accessed April 2022.
  7. Is Opioid Addiction Protected Under the ADA? EEOC Issues Clarifying Guidance. JD Supra. https://www.jdsupra.com/legalnews/is-opioid-addiction-protected-under-the-84425/. September 2020. Accessed April 2022. 

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