Many adults who misuse opioid painkillers are employed, but we don’t know how that use affects their work. In a new study, LDI Senior Fellow Abby Alpert and colleagues documented the impact of starting an opioid prescription on job performance among military service members. 

Job performance declined in the two years after individuals received a new opioid prescription in the emergency department, the researchers found. Those prescribed opioids were less likely to get promoted, more likely to receive a disciplinary infraction, and more likely to leave their jobs.

It’s the first evidence we have for how opioid use affects individual job performance, the authors write. “We know about the mortality consequences of the opioid epidemic and the market-wide impacts on employment,” Alpert said, “but there was little research about how opioid use affects individuals at work.”   

Job Performance and Opioid Use Research Enabled by Military Data

The military collects detailed data on all service members, making it an optimal setting to study the effects of opioid prescriptions on individuals. The investigators linked 2008-2017 anonymized personnel and medical records to create a data set that included measures of opioid use from medical claims and drug testing, and workforce outcomes such as promotions, demotions, physical fitness, disciplinary actions, and job separations. 

Emergency Department Opioid Prescribing was the Starting Point

Alpert and colleagues began their analysis with data from emergency department visits at military hospitals. As in civilian emergency departments, military patients cannot choose their emergency physicians, providing a degree of randomization for the study.

Service members who were not taking opioids at the time of their emergency department visit and who received an opioid prescription were followed for two years.

Physician Practice Patterns Drove Painkiller Prescriptions

The doctors in the study varied in their tendency to prescribe opioids, which shaped the study’s findings. Among opioid-naive people, after accounting for hospital, diagnosis, and patient characteristics, those treated by an emergency department physician with a higher opioid-prescribing rate were more likely to receive an opioid prescription.

Receiving an opioid prescription was associated with a higher likelihood of future misuse, as indicated by filling more than a 180 day-supply of opioids in the following year and by “doctor shopping.” Patients who received a prescription were also 34% more likely to have an opioid-positive result on a random drug screening test in the following year.

Job Performance Suffered After Opioid Prescriptions

The likelihood of receiving a promotion fell by 5% in the year after individuals began taking opioids. The effect was greater for white service members, who were much more likely than non-white service members to see a drop in their chances of being promoted after using opioids.

Demotions, which occur less often in general, increased by about 1% among opioid users. The effects of misuse on individual job performance persisted throughout the two-year study. Service members with less than a college education and those with preexisting mental health conditions had a greater likelihood of negative job outcomes after opioid initiation.

Behavioral Infractions and Job Separations Rose After Receiving an Opioid Prescription

Opioid use was associated with a 12% increase in the likelihood of a disciplinary action, such as tardiness, unexcused absences, poor attitude, or failure to perform assigned duties. However, more serious criminal activity did not accelerate. Likely a consequence of the behavioral findings, opioid use was linked to a higher probability of being denied a security clearance but had no effect on security clearance revocation.

Opioid initiation was also linked to a 9% increase in job separations. Discipline-related separations jumped by 26% and accounted for nearly half of the overall rise, with the remaining increase driven by voluntary separations. Notably, there was no observed increase in separations due to medical disability or death.

Importantly, opioid use did not appear to physically impair service members as performance on physical fitness tests remained unchanged.

The job performance findings likely apply outside the military, according to Alpert. “Opioid use likely affects people in all types of jobs, and you would see similar productivity losses,” she said.

Implications for Employers and Physicians

The research suggests that, beyond the negative job effects, opioid use causes recruitment and retention costs to go up.

Opioid prescribing in the emergency department has declined recently. However, physician behavior matters. The researchers estimate that reducing emergency department physician opioid prescribing rates would lower employee turnover for employers.

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The study, “Opioid Use and Employment Outcomes: Evidence from the U.S. Military” was published September 2025 in The Review of Economics and Statistics by Abby Alpert, Stephen D. Schwab, and Benjamin Ukert.

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