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Workplace Discrimination Against Patients on Suboxone Therapy

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July 22, 2021

The ability to get and keep a job is absolutely central to most of our lives. This is one of the reasons Congress passed the Americans with Disabilities Act (ADA). The ADA is a federal law that applies to most employers in the United States and prohibits discrimination against employees and job applicants based on their disabilities. The ADA also protects employees and job applicants by making it illegal for employers to discriminate against them for taking medications as prescribed. Therefore, a person who is taking Medication for Addiction Treatment (MAT) usually cannot be denied employment, be demoted, or be fired for it as long as they are taking the medications as prescribed. This includes buprenorphine/naloxone (Suboxone) and other opioid treatments like methadone. 

The bottom line is that it is usually illegal for employers to discriminate against people for taking buprenorphine/naloxone (Suboxone) as prescribed. However, this does not mean that people taking Suboxone are protected if they are also currently taking other drugs illegally. And there are exceptions that make it so not every employer and not every job is covered. 

Below we will summarize the current law on the subject, but this article is not legal advice. If you have been fired, demoted, or denied employment because of your legal use of prescribed medication, or if you have other legal questions, we strongly encourage you to contact a lawyer or legal aid organization in your state. This article is for informational purposes only and is not legal advice. 

Patients in Medication for Addiction Treatment (MAT) are covered under the ADA

The Americans with Disabilities Act (ADA) is a federal law that applies in every state. In addition to protections under the ADA, many states have their own additional laws to protect people with disabilities against discrimination. The state laws are always in addition to federal laws like the ADA, so the ADA sets a minimum, and many states have added extra protections on top of it. Therefore, if you have been discriminated against at work because you are taking Medication for Addiction Treatment (MAT), it is important to talk to a lawyer or legal aid organization in your state. 

Suboxone is a combination of two medications: buprenorphine and naloxone. Buprenorphine is a partial opioid, which means that even though it does not produce a “high” like full opioids do (e.g., heroin and oxycodone), and even though it is extremely safe and effective at helping people stop using opioids, some people still think of it as an abusable drug. In reality, Suboxone is rarely abused because it does not produce the intoxicating effects that full opioids do. Buprenorphine (and therefore Suboxone) does not show up on either standard or expanded opioid drug tests. For a drug test to show positive for buprenorphine, the drug tester would need to specifically order a drug test for buprenorphine (an ingredient in Suboxone). There is not good data on how many buprenorphine tests are given by employers, but we know that more than half of private employers in the U.S. require employees or job applicants to take some type of drug test. It is possible that an employee drug test will look for buprenorphine (and therefore Suboxone). Drug tests are not banned by the ADA, so employers can test employees and job applicants for any drugs they choose. What they do with the results might be governed by the ADA, but the tests themselves are not

Who is not protected by the ADA?

Taking buprenorphine/naloxone (Suboxone) is protected by the ADA. This is because of a “safe harbor” provision in the ADA, which protects former illegal drug users who are not currently taking illegal drugs. The ADA does protect employees and job applicants who take buprenorphine/naloxone (Suboxone) as prescribed, but there are exceptions.

“Current” illegal drug use

Employees and job applicants who currently use illegal drugs are not protected by the ADA even if they are taking Suboxone. (The word “currently” is defined differently by different courts and can sometimes mean many months of abstinence from illegal drugs.) Suboxone is not an illegal drug. Therefore, most employers cannot fire, demote, or refuse to hire based solely on a person taking Suboxone as prescribed. Relapsing on illegal drugs can be grounds for termination, which is one more reason why it is so important to take every precaution against relapsing on illegal drugs. Suboxone is extremely effective at preventing this kind of relapse

Some employers are not covered by the ADA

The ADA applies to private employers with at least 15 employees. If a person works for the federal government or for a private employer with fewer than 15 employees, that employer may not be bound by ADA rules about discrimination (there may be other laws, including state laws, that protect these employees against discrimination). Employers who are bound by the ADA are called “covered employers.” 

“Undue hardship” and “direct threat” exceptions

The ADA does require covered employers to make reasonable accommodations for employees with disabilities. But covered employers may not have to employ someone with a disability if making the accommodations would create an “undue hardship” for the employer. This means that if accommodating an employee’s disability would be very expensive or disruptive for the business, the employer will not need to make the accommodations the employee needs. It is very unlikely that taking Suboxone would cause an employee to need expensive or disruptive accommodations (or any accommodations at all), so for the vast majority of people prescribed Suboxone, this will not be an issue. Employers also do not need to employ someone if doing so would create a “direct threat,” but this is also an unlikely result of taking Suboxone. For instance, if it would be dangerous for a person to operate heavy machinery, the employer does not need to employ that person to operate heavy machinery. This makes sense, and the decision cannot be made arbitrarily – the employer should individually assess whether taking Suboxone would interfere with that applicant’s or employee’s “ability to effectively perform her job.”. The providers at Bicycle Health will usually be able to write letters to employers saying that this is not an issue. This will not always fix the problem, but it will often help. 

Disclosing Medication for Addiction Treatment (MAT) to employers

There is a key point about ADA protections for people taking buprenorphine/naloxone (Suboxone): It is almost always best for an employee or job applicant to disclose Suboxone treatment to their employer. Most employers are not allowed to make employment decisions based on a person’s legal medication use, but if an employee or applicant does not inform the employer about a prescription, the employer is allowed to assume that a positive drug test is the result of illegal use. Therefore, if someone is going to be tested for Suboxone by their employer, it is almost always best for the person to tell their employer about their Suboxone prescription. They can also submit a physician’s letter saying that the prescription will not interfere with their ability to do their job safely. The providers at Bicycle Health can usually write these letters. Employers may not always disclose what drugs and medications their drug tests look for, so disclosure about Suboxone is usually best. Ultimately, if you are unclear about what to do, we suggest contacting a legal aid organization or lawyer in your state for advice. Many legal aid organizations offer free consultations to people who cannot afford them.  

What to do if you’re being discriminated against

At the risk of sounding like a broken record, consulting with an attorney or legal aid organization in your state is best. If there are no affordable attorneys available, you can still take steps against the employer without one. The U.S. Equal Employment Opportunity Commission (EEOC) has guidelines on their website for how employees and job applicants can file discrimination complaints. In most cases, these complaints need to be filed within 180 days of the discrimination. Any type of employee may file a complaint with the EEOC (even part-time), but if your employer is the federal government, there are different steps to take. The team at Bicycle Health is available to provide medical guidance and can usually write letters to employers when needed. Bicycle Health does not provide legal advice. 

Contact us for more information

It is often critical for employees and job applicants to abstain from illegal drugs for many months or risk being considered a “current” user by their employer. Employers usually cannot discriminate against employees and job applicants for taking Suboxone, but they can discriminate against people who have recently used illegal drugs. Suboxone is very effective at preventing relapse to illegal opioids.

To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment in comparison to other common treatment options, call us at (844) 943-2514 or schedule an appointment here

Photo by August de Richelieu from Pexels

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