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During the 1970s, America battled another opioid crisis — heroin.² A large component of that earlier struggle was the use of methadone maintenance, a precursor to today’s medication-assisted treatment (MAT), which prescribes methadone or buprenorphine to treat individuals with substance use disorders through substances that will mitigate withdrawal while allowing them to function day-to-day. Politicians often oversold methadone as an easy solution to complex public health and societal issues, including crime. By doing so, methadone’s effectiveness became measured not necessarily by its effects on the health of patients, but by whether reductions in urban crime resulted. This illogical and unrealistic benchmark set methadone up to fail, and set the stage for the return of punitive approaches to people who used drugs during the 1980s.³ 

Proponents of methadone also believed that its use would enable heroin users to get and keep jobs. A 1970s U.S. federal government manual on methadone maintenance claimed that those addicted to heroin couldn’t hold down a job, but “a methadone patient, in contrast, can and often does get and hold a job. The result can be a stabilization of his whole life pattern.”⁴ Without this stabilization in wider society, many officials feared former addicts would slide back into drug use. At a 1974 New York conference on drug use and the workplace, one prominent banker argued that “we must accept the doctrine that an ex-addict without employment is an ex-addict without cure.”⁵ In practice, however, merging work and recovery proved complicated.

In the 1970s, just as now, people living with and recovering from substance use disorders faced prejudice and mistreatment at the hiring stage and in the workplace itself. There were no legal protections against being fired or not hired because of receiving methadone treatment. At a 1973 national conference on methadone, Joan Randall (a patient advocate and co-chair of the Methadone Coalition for Equal Opportunity) called out employers like Macy’s and the New York City Transit Authority for their refusal to hire methadone patients, although she claimed they were already employing hundreds of methadone patients they didn’t know about.