Individuals subject to provincial or federal workplace-related legislation or who are otherwise limited in their treatment options due to the requirements of their jobs (e.g., regulated health care professionals, pilots) may not have access to the full continuum of care for OUD (i.e., OAT) if they wish to remain active in their position. Clinicians should discuss the risks and benefits of each treatment option and the full continuum of care with each patient, with the understanding that alternative treatment programs (e.g., opioid antagonist medications and/or psychosocial treatments) may enable patients to maintain their employment.

Under current regulations, patients who opt for OAT may require modification of workplace duties. Clinicians should work collaboratively with patients and consult with regulatory bodies and other entities (e.g., relevant regulatory colleges, Canadian Medical Protective Association) regarding obligation to notify employers in these circumstances. 

It should be emphasized that workplace substance use-related policies that have precluded individuals in safety-sensitive occupations from receiving OAT have emerged without a firm evidence base or sufficient evaluation.461  There are currently jurisdictions, including some US states, that allow healthcare providers to receive buprenorphine-based treatments, and there is no substantial evidence associating use of buprenorphine/naloxone among health care providers with medical errors or other concerns.461 

Barriers to accessing OAT carry a high risk of return to unregulated opioid use, which, in turn poses significant danger to personal and public health and safety. In view of these risks, the BC Coroner’s Service Death Review Panel has recommended a revision of policies that have discouraged workers from seeking substance use care and precluded individuals in safety-sensitive positions from using evidence-based medications despite the absence of any compelling evidence that they significantly affect safety or workplace performance.462

Further work to identify and guide best practices for the treatment of OUD in this context is greatly needed.