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

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. However, you may face consequences for keeping your treatment a secret.

Federal laws like the Americans with Disabilities Act (ADA) may protect you from losing your job if you’re taking opioids (like methadone and buprenorphine) legally.[5]

However, an employer can disqualify you from a job if your MAT prevents you from doing your job safely and effectively.[5]

For example, if your MAT dose is too high, you may feel sluggish and sedated. If your job involves driving a forklift, your boss may attempt to fire you for your medications. Working while sedated could also put your safety (and that of your coworkers) at risk.

If you disclose your treatment early and ask for appropriate accommodations because of it, your job is protected.

Appropriate accommodations under the ADA might involve requests like adjustments to your schedule to allow you to go to appointments or time away from work to adjust to your medication.[11]

Know that most laws offer protection if you’re taking your medication as directed and not using street drugs. If you misuse your medications (or anything else), you lose those protections.

Understanding Your Rights

Three important types of laws apply to people who are working while in Medication for Addiction Treatment (MAT). Knowing what they are and how they work can help you protect your employment opportunities while you work on your substance use disorder (SUD).

The Americans with Disabilities Act (ADA)

The Americans with Disabilities Act protects you during your MAT. However, 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 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, but not all do.[4] 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 or accommodations to your work  schedule. But your employer may contest your work or schedule changes.

For example, your employer might suggest that MAT 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. 

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

Family Medical Leave Act (FMLA)

The Family Medical Leave Act (FMLA) provides employees with up to 12 weeks of unpaid leave per year, and your job and benefits are protected while you’re away. You can use FMLA to enroll in initial treatment for SUD.[8]

FMLA applies to public agencies, private and public schools, and companies with 50 or more employees. To access the benefits, you must have worked for your employer for at least 12 months for an accumulated 1,250 hours at a location where the company employs 50 or more people within 75 miles.[8]

State Laws

While it varies, some states have laws regarding drug testing results. These laws could protect you if you fail a urine test due to MAT.

These examples can help make state laws clear:[9]

• In Connecticut, an employer can’t typically conduct a drug test unless there is a reasonable suspicion that the employee uses drugs in a way that adversely affects job performance. Since MAT drugs don’t get you high, you may never be required to go through a drug test.
• In Delaware, only a small amount of jobs (like bus drivers) are subject to drug testing. If you hold a different type of job, your employer can’t test you.
• In Indiana, employers can prohibit illegal drugs in the workplace. Since MAT isn’t illegal, you shouldn’t be subject to testing.

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. 

How to Disclose MAT to an Employer

You want to tell your employer you’re using MAT as directed by a doctor. But how should you get started?

Follow these steps:

1. Get Your Doctor’s Help

Ask for a formal, written prescription and a letter (on letterhead) that explains your MAT will not affect your work or job performance.

This documentation can help you pass a drug test, as it proves you’re not using illegal drugs or misusing prescription medications. Instead, you’re simply treating a medical condition as recommended by your doctor.

2. Reach Out for Support

If you’re a member of a union, ask your representative to review your documents and attend a meeting with your employer.

Unions are designed to help workers fight for their rights and compete fairly at work. Your union rep may be willing to go to a meeting with you. Your rep may also help you understand the consequences of this decision and/or the resources you’re entitled to with your union membership.

3. Schedule a Talk

Find a time to meet with your union representative (if applicable) and your boss. Bring the paperwork from your boss, and outline any accommodations you might need.

In some companies, this conversation can’t stay private. For example, some states require supervisors to disclose employee mental health problems, even if the staff member doesn’t want accommodation.[10] However, some conversations end here.

4. Follow the Rules

If your employer asks for testing, 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.

5. Stay in Touch

A good employer should want you to be healthy 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 MAT 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 SUD or MAT at all, although you may choose 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.