Heroin and Employment

1 Introduction

1.1 Drug use, and particularly a drug conviction, is widely considered to be a barrier to employment with an increasing number of employers conducting pre-employment, "with cause", or random urine screening. Consequently, drug users experience difficulties in finding and maintaining employment, particularly in "safety-sensitive" occupations. Bowden et al reported "arrest record, both preceding and during treatment, based on official police data was the single factor significantly associated with employment"

1.2 It is well understood that most heroin addicts are unemployed, and consequently believed that heroin addiction is incompatible with holding down a job. However, heroin addicts receiving maintenance doses have found their lives to have been stabilised, and many undertake productive work. Nelson commented "Functional drug-abusing employees may work as productive members of a company for years without incident or detection. Cases have been documented of long-term heroin addicts with stable 10- and 20-year work histories."

1.3 Heroin is believed to be responsible for substantial lost productivity, however the effects of the drug itself are often confused with the effects of the "junkie" lifestyle. The primary barrier to heroin addicts working is not so much the effect of the drug itself, but of the lifestyle which surrounds illicit heroin use, with the constant need to "hustle" to get funds and "score" the next hit of street heroin. This lifestyle is very disruptive, and is incompatible with most occupations - "a lifelong condition associated with severe health and social consequences." The effects of heroin withdrawal can be severe, resulting in adverse changes to mood and cognitive function incompatible with work. In a general review of the effects of painkillers on occupational health, Payne concluded "all classes of analgesics may impair... neuropsychiatric functioning, which may influence job performance in specific instances."

1.4 In addition, studies which attempt to compare addicts with the general population face difficulties controlling for the tendency of addicts to suffer a variety of psychiatric disorders, in many cases pre-dating their substance abuse - i.e. differentiating the positions that persons with such disorders are either more likely to be heroin addicts or vice versa. During the so-called "British System" set up by the Rolleston commission early in the 20th Century and continuing until the end of the 1960s, many addicts received clean supplies of heroin from their doctors, and continued to function normally in society.

2 Detox Patients

2.1 Chutuape et al found "employment increased" following brief opiate detoxifications, however Tennent found repeated detoxifications had no effect on employment status.

2.2 In a 33-year follow up of long-term heroin addicts Hser et al noted "Long-term heroin abstinence was associated with less criminality, morbidity, psychological distress, and higher employment." Pauchard et al, in a 5-12yr follow-up in Switzerland, found "Findings on employment and marital status indicated a satisfactory social adjustment for a majority of subjects."

3 Methadone Maintenance Patients

3.1 Methadone maintenance is increasingly used to stabilise the lives of addicts, reduce criminal behaviour and allow gainful employment, Weber et al noted "The consequences in terms of employment are less clear and vary depending on the social setting." Appel, studying methadone patients using a continuous performance test, noted "Working and nonworking patient groups, and drug-free ex-addict and opiate-naive comparison groups were tested at high, moderate, and low signal rates. Groups did not differ overall in accuracy, response latencies, or commission errors. The working patients, however, performed better at the high than at the lower signal rates" Gossop et al reported that increasing methadone dosages "led to a reduction in illicit drug use and to improvements in social functioning."

3.2 Hartnoll at al found no differences in employment status between addicts receiving methadone and an experimental group receiving injectable heroin in maintenance doses, although the heroin recipients were less likely to drop out of the study and used street opiates less frequently.

4 Employed Addicts

4.1 Employment or the prospect of employment is considered a major motivator of decisions to seek treatment for drug abuse, and successfully completing treatment programs - "Patients who were employed at admission had a significantly longer mean length of stay and a higher rate of completion of the program than those who were not employed." Chronic unemployment a considered risk factor in developing addiction or relapse following treatment.

4.2 Murdoch, describing working addicts who had developed "drug" and "non-drug" identities noted "Employment status is often treated as a "risk factor" in epidemiologic studies of drug use. The process that underlies the supposed relationship has remained, however, essentially unexamined." Rothenberg studied 342 male addicts before and after methadone treatment, and commented "Although more than three-quarters of the patients were employed regularly during the period before addiction, only about one-quarter were employed while addicted.... The treatment program had only a moderate impact on patients' attitudes toward work and employment behavior." Studying British opiate addicts between 1968 and 1975, Wiepert et al commented "Forty-six per cent of patients in clinic treatment said they were working regularly at the end of the study (23 per cent at entry)."

4.3 Chen et al found 45% of Taiwanese heroin addicts were in employment, in Nigeria the figure was 31%, in Switzerland, Beninghof et al found 34% of heroin addicts to be working legitimately. In the USA, Corty et al found 50% of addicts seeking methadone treatment reported full-time employment currently or within the recent past.

4.4 French et al noted "most addicts have a strong interest in training and employment services, but their expectations about the impact of such services is often unrealistic." Arkin described the dilemma faced by doctors in the face of demands for confidentiality by drug-using patiernts and from employers for disclosure.

4.5 In a study by Levy of 95 former addicts with histories of simultaneous employment and undetected drug abuse (including on-the-job use by 91 of the 95 addicts), the following occupations were found: bank teller; mail clerk; secretary; delivery man; stock clerk; college registrar; typist; baker; nurses aide; medical supply clerk; messenger; pharmacy clerk; receptionist; teletype operator; men's clothing salesman; truck driver; busboy; telephone installer; roofer; clothing designer; assembly line worker; waitress; auto mechanic; security officer; postal worker; credit collector; plant manager; and rigger.

4.6 Caplovitz found that the stable worker-addict is more similar in basic characteristics to other workers than to nonworking addicts.

4.7 Morton, studying attitudes among employers in 1973 to employment of ex-addicts, found "The data strongly supported belief in the urgency of the need to employ... Appeals to human rights and social rights were judged to be important positive reinforcers to employment, and the economic argument a greater deterrent than fear or prejudice."

4.8 Doctors, in particular, have traditionally been susceptible to opiate addiction, and adept at obtaining clean (pharmaceutical) supplies while continuing to work undetected. A senior health advisor to the former Consevative government was a heroin addict diverting pharmaceutical supplies via forged prescriptions, but had otherwise conducted his duties in a way that no colleagues had suspected his addiction.

5 Summary - Heroin & Employment

5.1 Heroin use on work: A person tolerant to the effects of heroin could be expected to function relatively normally under the influence of a "normal" dosage of the drug for that person.

5.2 Many addicts receiving stable maintenance doses of methadone or diamorphine are able to work normally with their condition undetected for many years, including individuals in high-status occupations.

5.3 Withdrawal from heroin whilst at work would create severe problems for the employee, rendering him or her unfit do do virtually any job, and a liability to others in safety-sensitive occupations.

5.4 There are studies which suggest opiate addicts to show impaired psychomotor or cognitive performance, however these generally fail to differentiate between the drug effects and the chaotic lifestyle normally involved.

5.5 Work on Heroin Use: Employed status is widely regarded as a stabilising and motivating factor for addicts to seek treatment and minimise street drug use.

5.6 Having to report for work restricts the opportunities to buy and use heroin, and indeed to sell heroin, during working hours.

5.7 Where the employee works away, opportunities to buy or sell heroin are further restricted to days when the employee is home, unless supplies can be obtained locally to the job.

5.8 With regular access to money (weekly wages or montly salary) the purchase pattern is likely to mirror availability of funds. Thus a weekly-paid worker may purchase a week"s supply at one time, and a montly salaried worker a months supply, taking advantage of bulk discounts to reduce the costs of personal use.

5.9 Given the need to avoid withdrawal on the job, I would expect the addicted employee to take steps to ensure sufficient supplies were available to sustain use when working away.