'You Should Be Helping Him, He'S Trying To Do Something About It': The Dilemma Of Heroin Use, Agonist Opioid Treatment And Employment

Background: Approximately 20% of people starting an episode of specialist drug treatment in England are in work, but few gain employment as treatment progresses. Although much has been written about the barriers to employment, less research has been conducted on people who do manage to work on agonist opioid treatment (AOT). This study set out to explore the interaction between heroin use, AOT and employment. Methods: We conducted semi-structured interviews with 10 individuals receiving AOT in full-time employment recruited from a community drug treatment centre in the English West Midlands. All interviews were transcribed, and data relating to employment, treatment and illicit drug use were systematically coded using the Iterative Classification process and subjected to thematic analysis. Results: AOT was considered an important factor in allowing this group to obtain full time employment, but the majority were still using some heroin. AOT and the income derived from working had allowed them to pick and choose when they used drugs, but their reliance on their income from employment meant that they couldn't devote significant time to detoxification and rehabilitation strategies. At the same time, promotion opportunities were limited by the perceived stigma of AOT. Conclusions: These findings suggest a different approach is required to help employed opiate users receiving AOT than for those who are unemployed. More work with employers to increase the understanding of AOT and overcome the stigma of drug use may be required.