Medication-Assisted Treatment for 

Opioid Use Disorder

Summary

The opioid overdose epidemic continues 

to claim lives across the country with a 

record 47,600 overdose deaths in 2017. 

(This number represents 67.8% of the 

70,237 overdose deaths from all drugs) 

[CDC 2018a]. More Americans now die 

every year from drug overdoses than in 

motor vehicle crashes [CDC 2016]. The 

crisis is taking an especially devastating 

toll on certain parts of the U.S. workforce. High rates of opioid overdose 

deaths have occurred in industries with 

high injury rates and physically demanding working conditions such as construction, mining, or fishing [Massachusetts Department of Public Health 2018; 

CDC 2018b]. Certain job factors such as 

high job demands, job insecurity, and 

lack of control over tasks have also been 

linked to opioid use [Kowalski-McGraw 

et al. 2017]. Medication-assisted treatment (MAT) (also known as medicationbased treatment*) has been shown to be 

effective for many people with opioid 

use disorder [SAMHSA 2015b; National Academies of Sciences, Engineering, 

and Medicine 2019]. In addition to providing general information about MAT, 

this document provides information for 

employers wishing to assist or support 

workers with opioid use disorder.

Background

Challenges related to prescription drug 

misuse, illicit drug use, and addiction 

affect individual workers, their families, and both large and small businesses. In a 2017 National Safety Council 

survey, 70% of employers reported suffering the negative effects of prescription drug misuse; noting positive drug 

tests, absenteeism, injuries, accidents, 

and overdoses [Hersman 2017]. In 

2013, the total U.S. societal costs of prescription opioid use disorder (OUD) 

and overdoses were $78 billion. Of that, 

about $2.8 billion was for treatment 

[Florence et al. 2016].†

In 2016, individuals with insurance 

coverage received $2.6 billion in services for treatment of opioid addiction 

and overdose, a dramatic increase from 

$0.3 billion in 2004 (based on claims 

data from large employers). Of that 

$2.6 billion, $1.3 billion was for outpatient treatment, $911 million was for 

inpatient care, and $435 million was 

for prescription drugs [Cox et al. 2018]. 

Employers may save up to $2,607 per 

worker annually (based on 2012‒2014 

data) by getting workers into treatment 

[NSC et al. 2016; NORC].

Despite these findings, 80% of individuals in need of treatment for a substance 

use disorder in 2016 did not receive 

treatment [CBHSQ 2017]. Making medication-assisted treatment (MAT) more 

readily available to people with OUD 

can help diminish the opioid crisis in the 

United States.

*Note that some experts recommend the term “medication-based treatment” or MBT instead 

of MAT. This change in nomenclature aligns with the premise that OUD is a chronic disorder 

for which medications are first-line treatments (often an integral part of a person’s long-term 

treatment plan) rather than complementary or temporary aids on the path to recovery [National Academies of Sciences, Engineering, and Medicine 2019].

†The White House Council of Economic Advisers [CEA 2017] estimated the economic cost of 

these deaths related to opioids “using conventional economic estimates for valuing life routinely used by U.S. Federal agencies.” The CEA report “also adjusts for underreporting of opioids in overdose deaths, includes heroin-related fatalities, and incorporates nonfatal costs 

of opioid misuse.” CEA estimates that in 2015, the economic cost of the opioid crisis was 

$504.0 billion, or 2.8 percent of GDP that year.”

Centers for Disease Control

and Prevention

National Institute for Occupational 

Safety and Health

Treatment

What is medicationassisted treatment (MAT)?

MAT uses medications approved by the 

U.S. Food and Drug Administration 

(FDA) in combination with counseling 

and behavioral therapies to treat OUD 

involving misuse of either prescription 
or illicit opioids. The medications reduce the cravings for 

and the euphoria (extreme pleasure) experienced with opioids [SAMHSA 2015b]. Some medications may also reduce 

the risk of subsequent overdose. Three drugs are commonly 

used in MAT:

 Methadone is a full opioid agonist, which means that it 

works similarly to other opioids such as heroin, morphine, 

or fentanyl. Unlike other opioids, methadone acts much 

more slowly in the body. This slower action helps to reduce the euphoric highs and lows associated with other 

types of opioids while diminishing withdrawal symptoms. 

Methadone treatment is available only through a federally regulated opioid treatment program (OTP) and requires those in the program to report to the OTP daily or 

near daily to obtain the medication. Methadone itself can 

be addictive and misused, so it is important that it be used 

only as prescribed and under medical supervision.

 Buprenorphine is a partial opioid agonist, which means 

that it does not have the full effect of other semi-synthetic opioids in the same class, such as heroin or oxycodone. The drug is long-acting, works slowly, and, similar to 

methadone, helps prevent the intense cravings and withdrawal symptoms associated with opioid use. Buprenorphine is available by itself or in combination with naloxone, an opioid antagonist that reverses or prevents the 

effects of opioids. Adding naloxone discourages the misuse of buprenorphine. While naloxone has no effect when 

the combination (buprenorphine/naloxone) is used as directed by sublingual tablet or buccal film, the naloxone 

does work to block the effect of buprenorphine when the 

combination is injected or used nasally. MAT using buprenorphine is available in healthcare settings outside of 

an OTP under certain circumstances. The Drug Addiction Treat Act of 2000 allows physicians who meet certain qualifications to obtain a waiver to treat OUD with 

buprenorphine in primary care settings. Such waivers 

may make this treatment more accessible to those seeking 

treatment. Like methadone, it is possible for buprenorphine to be misused when not taken as prescribed. 

 Naltrexone is an opioid antagonist that blocks the euphoric and sedative effects of opioids such as heroin or 

morphine. It also reduces cravings for opioids [SAMHSA 2015b; NIH 2018a]. This medication may also be prescribed outside of an OTP.

Table 1 lists the formulations and possible side effects of each 

of these medications.

In addition to the side effects, serious drug interactions between MAT and other drugs (including alcohol) are also 

possible.

What are the typical steps in medicationassisted treatment (MAT)?

Treatment for OUD begins with stabilization and opioid 

withdrawal management followed by medication maintenance combined with counseling or behavioral therapy. Underlying health conditions that may be influencing opioid 

Table 1. Formulations and side effects of medications used in medication-assisted treatment (MAT).

Drug Formulations‡ Potential adverse side effects

Methadone Tablet (Dolophine)

Oral concentrate (Methadose)

Respiratory depression, heart rhythm problems, low 

blood pressure, upset stomach, vomiting, constipation, dizziness, light-headedness, sedation, weakness

Buprenorphine

(Subutex)

Patch (Butrans)

Intradermal implant (Probuphine) 

Injection (Sublocade, Buprenex)

Sublingual tablet

Constipation, nausea, vomiting, headache, drowsiness, sedation, insomnia, lack of energy, weakness

Buprenorphine/

Naloxone

(in combination)

Buccal film (Belbuca, Bunavail)

Sublingual tablet (Subutex, Zubsolv)

Sublingual film (Cassipa, Suboxone)

Constipation, nausea, vomiting, headache, insomnia, 

lack of energy

Naltrexone Oral (Revia, Depade)

Injectable suspension for extended 

release (Vivitrol)

Upset stomach, vomiting, diarrhea, stomach pain, 

headache, anxiety, dizziness, drowsiness, lack of energy, joint and muscle pain

Sources: NIH 2018a; IBM Micromedex DRUGDEX 2018; ASAM 2015; Leshner 2019

‡

Some formulations have generic versions available.
use should also be addressed. In later phases of treatment, 

healthcare providers work with patients to determine when 

the medication(s) can be tapered or stopped.

What is the typical length of treatment?

Length of treatment is highly variable with all three MAT 

drugs and spans from months to years. Long-term treatment 

is often needed to prevent relapses. A decision to taper off 

medication depends on factors such as compliance, tolerance, 

adverse effects, and a patient’s progress toward abstinence 

from opioids. Tapering off often takes several months [ASAM 

2015]. Removing someone from MAT abruptly or prematurely may increase the risk of relapse and subsequent overdose.

What is an opioid treatment 

program (OTP)?

OTPs are housed in facilities that provide substance abuse 

treatment including MAT for OUD. MAT patients treated in 

OTPs must receive counseling, which can include different 

forms of behavioral therapy. These facilities are accredited 

by the Substance Abuse and Mental Health Services Administration (SAMHSA), licensed to operate by the state where 

located, and registered with the U.S. Drug Enforcement 

Administration (DEA) [SAMHSA 2015a]. Some MAT medications are only available through an OTP, while others can 

be obtained in other healthcare settings.

Can drugs used as part of medicationassisted treatment (MAT) cause side 

effects that impair work activities?

Research has shown that, when provided at the proper dose, 

medications used in MAT have no adverse effects on a person’s intelligence, mental capability, physical functioning, 

or employability [SAMHSA 2015b]. However, side effects 

of the medication(s) may impair a person’s ability to drive, 

operate heavy machinery, or perform other functions safely. 

Side effects will vary depending on the specific medication, 

dosage, and duration of treatment. Workers with safety-sensitive jobs may be subject to restrictions or limits on the jobs 

or duties they perform while using these medications. These 

restrictions may include operating motor vehicles, forklifts, 

cranes, and other types of heavy equipment, or making decisions that can affect the safety and health of others (such 

as dispatchers, operations managers, or other jobs requiring high levels of cognitive function or judgement). Caseby-case determinations by qualified occupational healthcare 

providers may be necessary based on the potential for impairment resulting from MAT. Reasonable accommodations 

by the employer should be considered when appropriate. 

When starting MAT, the worker should avoid driving and 

hazardous work activities until dosages are stabilized, side effects are managed, and impairment risks related to the work 

to be performed are assessed. Side effects often diminish over 

time [ASAM 2015; IBM Micromedex DRUGDEX 2018].

Gaining Access to MedicationAssisted Treatment (MAT)

Does employer health insurance cover 

medication-assisted treatment (MAT)?

The Affordable Care Act requires most insurers to cover 

treatment for substance use disorder. In addition, the Mental 

Health Parity and Addiction Equity Act (MHPAEA) of 2008 

requires health insurers and group health plans to provide 

benefits for behavioral health services at the same level as 

primary care. However, insurers may not cover all types of 

treatment for substance use disorder or may cover only certain treatments [SAMHSA 2017]. In addition, employers 

can often play an important role in influencing the level of 

healthcare and pharmacy benefits included in employersponsored plans for the treatment of substance use disorders.
How can workers find medication-assisted 

treatment (MAT) healthcare providers?

Workers should turn to their physician and healthcare insurance provider for assistance. Insurers can provide information about coverage and often have access to a network 

of preferred MAT providers. Some employers provide Employee Assistance Programs (EAP) offering counseling, support, and referrals. EAP and other member assistance programs  (present in many labor organizations) give workers 

a safe, confidential space to talk about personal issues (including substance use disorder) and can provide referrals to 

local treatment facilities [ASSP 2018]. These types of programs can help foster a positive, supportive organizational 

culture that reduces the fear of serious repercussions when 

workers seek care.

Many states offer treatment programs for those without insurance coverage. Once a provider is identified, the worker should contact the provider for an appointment. Some 

programs are also able to offer walk-in services. In times 

of crisis, many people access services through hospital 

emergency rooms.

Other resources and information about locating addiction 

treatment centers can be found at https://findtreatment.samhsa.gov/ or by calling the National Helpline at 1-800-662-4357.

Regulations, Rights, and Worker 

Protections

Are opioid treatment programs (OTP) 

regulated?

OTPs are required by law to be accredited to help monitor 

the quality of care provided and the appropriate dispensing 

of opioid treatment drugs [SAMHSA 2015a; The Joint Commission 2018]. For further information about these federal 

regulations, please refer to The Substance Abuse and Mental 

Health Services Administration’s (SAMHSA) Federal Guidelines for Opioid Treatment Programs.

What rights and protections are available 

to workers who have opioid use disorder 

(OUD)?

Employers should protect the privacy and confidentiality of 

all workers’ health-related information.

For employers subject to the Americans with Disability Act (ADA), federal law safeguards people against job 

discrimination if they are undergoing MAT. Both the ADA 

and the Rehabilitation Act of 1973 forbid most employers 

from firing, refusing to hire, or discriminating (in the terms 

and conditions of employment) against any qualified job applicant or worker on the basis of a disability [Legal Action 

Center 2009]. In addition, the ADA, the Rehabilitation Act, 

and the Family Medical Leave Act (FMLA) give workers the 

right to take medical leave, which can include alcohol or drug 

treatment.

These federal laws cover employers in different ways. The 

ADA applies to all state and local government agencies and 

to private employers with fifteen or more workers. The Rehabilitation Act applies to federal agencies and to state and local 

government agencies and private employers that receive federal grants, contracts, or other federal aid. When federal law 

covers employers, they are prohibited from denying a job to, 

or firing, a worker based on a worker’s participation in MAT. 

They also must offer reasonable accommodation as needed to 

allow those with a disability to perform their job duties, unless the accommodation would cause undue hardship to the 

employer [American Addiction Centers 2018].

In addition to giving workers with OUD the right to take 

leave to focus on treatment, the FMLA also offers employers 

resources for managing that leave, and places other obligations and restrictions on the rights of workers.

More information from SAMHSA can be found here:

Know Your Rights: Rights for Individual MedicationAssisted Treatment.

How Employers Can Help

Employers can take the following steps to contribute to prevention and treatment of OUD [NIOSH 2018; CDC 2017; 

Massachusetts Department of Public Health 2018; National 

Safety Council 2018; Kowalski-McGraw et al. 2017]:

 Ensure that work is safe and working conditions do not 

lead to worker injury or illness, or contribute to painful 

chronic conditions.
 Identify clinics that provide evidence-based treatment for

injured workers, including the adherence to opioid prescribing guidelines.

 Provide adequate leave and other benefits after workplace

injury including flexibility in scheduling and receiving

medical care, support during recovery, and return to work.

 Take steps to manage workplace stressors and job insecurity to the extent possible.

 Take steps to decrease the stigma associated with substance misuse through awareness building and supervisor

training.

 Educate workers about how drugs impair work activities, including driving, and encourage them to notify

their employers if they are taking medications that may

affect their ability to work safely so that a safe solution

can be determined.

 Develop and communicate clear drug-related workplace

policies that include an offer of assistance to workers

with OUD.

 Offer comprehensive treatment options to workers with

OUD, including healthcare coverage that provides MAT.

 Work with health plan providers and pharmacy benefit

managers to attend to inclusion of such coverage in employer health plans.

Employers should also consider the following steps when 

arranging services for their workers, or when working with 

others to select an MAT program or provider:

 Ensure that the MAT program is licensed or certified by

your state.

 Verify that the MAT program offers FDA-approved medications to treat OUD.

 Check if the provider can offer or refer for psychological,

social, and family support in the treatment program.

 Look for independent evidence that the program offers

effective and proven treatment whenever possible

[SAMHSA 2019].

Acknowledgments

This document was prepared by John Howard, MD, MPH; 

Lauren Cimineri, PharmD MPH; Tamekia Evans, MPH; L. 

Casey Chosewood, MD, MPH; Susan Afanuh, MA; National 

Institute for Occupational Safety and Health.

Suggested Citation

NIOSH [2019]. Medication-assisted treatment for opioid 

use disorder. By Howard J, Cimineri L, Evans T, Chosewood 

LC, Afanuh S. Washington, DC: U.S. Department of Health 

and Human Services, Centers for Disease Control and 

Prevention, National Institute for Occupational Safety and 

Health, DHHS (NIOSH) Publication No. 2019-133, https://

doi.org/10.26616/NIOSHPUB2019133

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For More Information

More information about opioids in the workplace can be found 

at https://www.cdc.gov/niosh/topics/opioids/default.html

Additional Resources

Certification of Opioid Treatment 

Programs

https://www.govinfo.gov/app/details/CFR-2007-title42-vol1/

CFR-2007-title42-vol1-part8

http://dptbeta.samhsa.gov/pdf/FederalGuidelines2015_508.pdf

The Federal Guidelines for Opioid Treatment Programs – 2015

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Medication-Assisted Treatment

https://www.samhsa.gov/medication-assisted-treatment/

treatment#medications-used-in-mat

https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone

https://www.samhsa.gov/medication-assisted-treatment/opioidtreatment-programs

Treatment and Costs

https://www.samhsa.gov/medication-assisted-treatment/treatment/insurance-payments

https://www.rehabcenter.net/insurance-cover-methadone-clinics/

https://www.opioidtreatment.net/insurance-coverage/

methadone-clinics/

https://www.drugabuse.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-much-does-opioidtreatment-cost

Using Naloxone to Reverse Opioid 

Overdose in the Workplace

https://www.cdc.gov/niosh/docs/2019-101/default.html

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DOI: https://doi.org/10.26616/NIOSHPUB2019133

DHHS (NIOSH) Publication No. 2019-133

May 2019