Methadone and employment

These findings were characterized as “counterintuitive”.

Findings from multivariate analyses initially showed no association between treatment enrollment and employment transitions. However, when a distinction was made between MMT and other addiction treatment modalities, it became clear that the relationship between addiction treatment and employment outcomes for IDU in this setting was contingent upon the type of addiction treatment: enrollment in non-MMT forms of treatment increased the odds of making an employment transition, whereas MMT enrollment had the inverse effect. This mode-specific association was echoed in analyses of transitions into temporary, informal, and under-the-table work, which had no association with MMT enrollment but also saw a strong positive association with non-MMT forms of addiction treatment.

Possible explanations?

We’re expecting too much of these poor folks:

The observed systematic differences in employment outcomes might plausibly be related to individual-level characteristics or circumstances that either inhibit transitions to employment and systematically apply to those individuals enrolled in MMT or lead to both MMT enrollment and nonemployment. For example, in contrast to abstinence-based forms of treatment, MMT is geared toward stabilized maintenance (Ward, Mattick, & Hall, 1994) and aimed at reducing the major risks, costs, and harms associated with untreated opiate addiction ( [Rosenbaum et al., 1996], [Ward et al., 1999] and [World Health Organization, 2004]). It may therefore be a part of the early stages of addiction treatment and rehabilitation, and the initiation of labor market activity might not be expected to follow MMT enrollment in the same way that it would for other treatment modalities.

Cognitive impairment?

…methadone has been shown to impair cognitive performance (Darke, Sims, McDonald, & Wickes, 2000) and may impact capacities to undertake work.

Another variation on the idea that we’re expecting too much.

Elsewhere, explanations for differences in labor market outcomes among people with substance use disorders, such as lower education levels, work histories, or motivation (Svikis et al., 2012), may be disproportionately prevalent among those enrolled in MMT. As with non-drug-using populations (Dooley, Fielding, & Levy, 1996), individuals may also have differing capacities related to physical or mental health that inhibit their ability to seek and find employment.

Maybe it’s because they’re still getting high.

Finally, the common presence of concurrent and ongoing drug use by individuals enrolled in MMT ( [Barnas et al., 1992] and [DeMaria et al., 2000]) may preclude transitions into employment or temporary, informal, or under-the-table income generation.

Watch the whole film here.

UPDATE: Matt reminded me of some reasons it seems a little silly for these findings to be considered so counterintuitive. From our buprenorphine maintenance position paper:

Amato L, M. S. (2011). Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database of Systematic Reviews.;

Schwartz RP, Kelly SM, O’Grady KE, Gandhi D, Jaffe JH. (2011). Interim methadone treatment compared to standard methadone treatment: 4-month findings. J Subst Abuse Treat. 41(1):21-9.;

Helwick C (2010, May 24) For Prescription Opioid Dependence, Relapses Associated With Shorter Treatment Course. Retrieved October 25, 2011 from, http://www.medscape.com/viewarticle/722342;

Fiellin DA, Pantalon MV, Chawarski MC, Moore BA, Sullivan LE, O’Connor PG, Schottenfeld RS. (2006). Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence. N Engl J Med. 355:365-374

Amato et al.’s meta-analysis of methadone maintenance treatment (MMT) found no benefit from added psychosocial support. Schwartz et al. compared interim methadone (IM) patients receiving no counseling with standard methadone (SM) patients receiving counseling. IM patients tested positive for illicit drugs at the same rate but engaged in less criminal activity and spent less money on drugs. These findings suggest that MMT patients are not “available” to benefit from these interventions which are the mainstay of abstinence based recovery. Helwick reported similar findings from a presentation by Roger Weiss, MD on the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Patients receiving buprenorphine and counseling fared no better than patients without the counseling. Fiellin, et al. reported similar findings. Again, suggesting that ORT patients are not “available” to benefit from these interventions which are the mainstay of abstinence based recovery.