A stock image of a pill bottle.

Two linked studies led by UCLA Fielding School of Public Health and School of Nursing researchers have found strong associations between drug misuse generally and opioid misuse specifically among unemployed Americans, who were found to have a 40% higher likelihood to misuse opioids than those working 35-40 hours per week.

“With emergency visits for opioid overdoses and opioid overdose deaths on the rise, particularly during the COVID-19 pandemic, there is an urgent need for government policy interventions and the mobilization of political will,” said Dr. Jian Li, UCLA Fielding School of Public Health professor of environmental health sciences and professor in the UCLA School of Nursing, who has led the research. “These new studies show that stable employment and supportive work environments may act as major social determinants of health in the context of the opioid crisis.”

The research includes work published in the peer-reviewed Journal of Psychiatric Research and the International Journal of Environmental Research and Public Health (IJERPH) by separate, but overlapping international teams from UCLA, Hofstra University in New York, and universities in Sweden, Germany, and Switzerland.

One study – “Associations of employment status with opioid misuse: Evidence from a nationally representative survey in the U.S.” – is set for publication in the July edition of the Journal of Psychiatric Research, but is currently available electronically. The other – “Effort–Reward Imbalance at Work and Drug Misuse: Evidence from a National Survey in the U.S.” – has already been published by the IJERPH.

The Psychiatric Research study found significant associations of unemployment with opioid misuse in a large and nationally representative sample of 40,143 adults, using data from the annual National Survey of Drug Use and Health (NSDUH) in the U.S. That work found that along with employment, individuals who were in school or pursuing training also were less likely to misuse drugs than those who were unemployed, said Timothy Matthews, a doctoral student in the Department of Environmental Health Sciences at the UCLA Fielding School of Public Health and first author of the study.  

“One critical result is that participants who were in school or involved in vocational training had lower odds of opioid misuse, demonstrating a protective role of further education and skill development in drug misuse outcomes,” Matthews said. “Overall, we found unemployment was significantly associated with opioid misuse; interestingly, short or long working hours were not.”

In the related IJERPH study, however, researchers found that a stressful work environment may act as a determinant of drug misuse, said Dr. Marissa Seamans, UCLA Fielding School of Public Health assistant professor of epidemiology and a co-author.

“We found that those reporting hard physical or mental effort, or both, in jobs where they experienced little chance of promotions, esteem from their employers for the work they did, or little job security, were those at highest risk of drug misuse,” Seamans said. “This included opioids, but also misuse of amphetamines, cocaine, or hallucinogens. One slightly different finding was for cannabis misuse; that was uniquely related to high physical effort.”

The findings of both teams suggest a need for labor issues and work-related stress to be considered a significant part of the opioid crisis in the U.S., and for employers, workers, and government to consider joint responses, the researchers said.

“Our objective in these studies was to assess the contribution of work stress, in this case, as measured by effort-reward imbalance, to drug and opioid misuse outcomes,” said Dr. Liwei Chen, UCLA Fielding School of Public Health associate professor of epidemiology, and a co-author. “Government and employers may want to consider policies targeting on stable employment as a key public health outcome.”

Methods: These two studies were based on the National Survey of Drug Use and Health (NSDUH), and the national population-based Midlife in the United States (MIDUS) Study, respectively. Data on various work-related stressors and types of employment were used to examine associations with opioid and drug misuse outcomes. The MIDUS and NSDUH samples included participants across a diverse range of social demographics and occupations.

Funding: This work was sponsored by a grant by the Council on Research of the Academic Senate of the Los Angeles Division of the University of California (Grant No.: J. Li FRG 20-21). Matthews and Li were also supported by a Start-Up Grant from the University of California, Los Angeles to Li as a new faculty member.

Data availability statement: The datasets used are publicly available from:

https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2020-nsduh-2020-ds0001, and



Matthews, T. A., Sembajwe, G., von Känel, R., & Li, J. (2022). Associations of employment status with opioid misuse: Evidence from a nationally representative survey in the U.S. Journal of Psychiatric Research, 151, 30–33. doi.org/10.1016/j.jpsychires.2022.04.001

Li, J., Matthews, T. A., Chen, L., Seamans, M., Leineweber, C., & Siegrist, J. (2021). Effort-Reward Imbalance at Work and Drug Misuse: Evidence from a National Survey in the U.S. International Journal of Environmental Research and Public Health, 18(24), 13334. doi.org/10.3390/ijerph182413334