Can Treatment with Medications for Opioid Use Disorder Improve Employment Prospects? Evidence from Rhode Island Medicaid Enrollees

The nation’s long-standing crisis of opioid abuse intensified during the COVID-19 pandemic, with opioid-related deaths rising to nearly 81,000 in 2021, an increase of more than 60 percent from just two years earlier. Also during the pandemic, the labor force participation rate in the United States fell precipitously, and as of September 2022 it remained depressed by more than a full percentage point relative to its February 2020 level despite record numbers of job openings in 2021 and 2022. The unfortunate confluence of labor shortages and record-setting opioid mortality highlights the need to better understand the relationship between opioid use and employment and prompts the question of whether effective medications for opioid use disorder (OUD), which have been shown to save lives, might also help to bolster the employment prospects of OUD patients and reduce the economic burden of OUD on society. This report, focused on Medicaid enrollees in the state of Rhode Island, seeks to answer that question. It presents two primary findings. First, the results show that individuals diagnosed with OUD are less likely to be employed compared with other Medicaid enrollees and that their employment tends to be more intermittent; further analysis shows that these differences do not merely reflect other fixed factors affecting employment that might be common among individuals with OUD. Second, the report finds that OUD patients treated with the medication buprenorphine experience increased job-finding rates, especially in the period shortly after they first start taking the medication. These results, while modest in magnitude, suggest that the same treatment protocol already shown to prevent overdoses and save lives also holds promise for helping OUD patients return to work. On the other hand, treatment with methadone (another medication approved for OUD by the US Food and Drug Administration) is not associated with any significant increase in the job-finding rate among OUD patients. The contrasting results for buprenorphine versus methadone point to the fact that patients treated with methadone tend to have more severe opioid use disorders and may face additional barriers to employment compared with those treated with buprenorphine. This report uses a unique data set that links payroll employment records with information on medical diagnoses and health-care utilization among Medicaid enrollees in Rhode Island. The state of Rhode Island represents an appropriate context for studying the relationships between opioid use, employment, and treatment. In 2020, the state’s age-adjusted opioid-related mortality rate was the 10th highest in the United States, according to data from the Centers for Disease Control and Prevention, and Medicaid enrollees accounted for a disproportionate share of those deaths. Rhode Island has been a pioneer in tackling the opioid crisis, and it recently became the first state in the nation to deploy a mobile methadone van to serve neighborhoods lacking a specialty treatment facility.