Heroin and Employment
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
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."
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."
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
et al found "employment increased" following
brief opiate detoxifications, however Tennent found repeated
detoxifications had no effect on employment status.
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
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."
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
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.
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
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.
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.
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.
found that the stable worker-addict is more similar in
basic characteristics to other workers than to nonworking
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
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
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
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.