12/19/2025
“The war on drugs is a war on workers”
by Byron Wood Dec 18, 2025 Briarpatch magazine
“Nola* became addicted to a prescription opioid – Dilaudid – after her doctor prescribed it for two years due to pain resulting from an undiagnosed bladder disease.
When her doctor took her off the medication, she went through a hellish cold-turkey withdrawal process. After being off opioids for three months, she shared information about her past substance use challenges with an addiction physician whom she trusted. He recommended opioid agonist therapy (OAT) – a category of medications proven to reduce withdrawal symptoms, cravings, relapse, pain, and the risk of overdose death – and prescribed Suboxone.
What happened next was like som**hing out of a nightmare. Without informing her, the physician contacted Nola’s employer and professional regulatory body and told them about her prior substance use challenges and newly-prescribed Suboxone
This meant she was forced to stop using Suboxone and the anti-anxiety medication she’d been prescribed since she was a teenager.
Nola’s employer and regulatory body told her that she could no longer work and suspended her nursing licence pending a medical assessment.
After a month off work Nola was required to undergo an independent medical exam (IME) with a private physician assigned to her and charged to her union. These IMEs typically cost around $2,500, according to research published by lawyer Jonathan Chapnick while he was working as a workplace investigator and adjudicator. The IME doctor diagnosed her with Substance Use Disorder (Opioid Use Disorder and Alcohol Use Disorder) and made recommendations that her employer and regulatory body incorporated into a 3-year contract that she had to sign. If she didn’t follow the terms of the contract she would lose her job and nursing licence.
“I was confused and panicked and had no idea what was going on,” she recalls.
Terms included remaining completely abstinent from all psychoactive substances for the three-year contract period, unless approved by the IME doctor. This meant she was forced to stop using Suboxone and the anti-anxiety medication she’d been prescribed since she was a teenager. She was also subject to invasive procedures including random urine drug testing and later, fingernail and hair testing.
Nola is one of many workers who enter into surveillance programs administered by their employers out of fear of losing their livelihoods.
For over 12 years she had provided psychiatric nursing care in the small rural B.C. town where she grew up. Her job meant everything to her.
“There were never any complaints from my patients, any concerns about my nursing practice, or any concerns that I was impaired by substance use at work,” she says.
Nola is now a member of Workers for Ethical Substance Use Policy (WESUP), a group of mostly unionized workers who have been harmed by their employers’ substance use policies. Members of WESUP provide peer support for each other and fight to build workplace policies that are supportive, not punitive.
WESUP has found that punitive workplace substance use policies lead to members avoiding health care services and argues that supportive policies will increase the likelihood that workers will access care, resulting in a healthier workforce and safer workplaces.
WESUP members include people from across Canada who work in trades, transportation, industry, education, emergency responders, health care, government, and other sectors.
Drug policy is killing workers
WESUP is trying to bring attention to the fact that drug policy is a working-class issue and unions have an obligation to protect workers from these policies.
Workers are being killed by toxic drugs. Instead of offering help, many employers – like Nola’s – force workers who struggle with substance use challenges into harmful, profit-driven systems of surveillance and control, push them out of the workforce, and put them at increased risk of overdose death by denying them access to OAT and other care based in harm reduction principles.
There are many reasons someone might use drugs on or off the job ranging from recreation on one's personal time to managing difficult working conditions, both physically and mentally.
Making drugs illegal does not protect people against the potential harms of drug use; in fact, it does the complete opposite.
Those working in the construction, trades, and transportation industries – where work is physically demanding and injuries are common – have experienced the highest rate of opioid overdose deaths. Workers denied paid sick leave sometimes seek opioids to treat their pain quickly so they can keep working. Employers then punish them for doing so.
In the early 1900s, o***m, morphine, and co***ne were all available through pharmacies. You knew what you were getting and what the dose was. Outlawing these drugs forced people to rely on the black market. They had to figure out how much to use without overdosing. As the drug supply became increasingly toxic, those accessing it no longer knew what substance they were getting or in what potency, making the drugs even more unpredictable and dangerous.
Between January 2016 and March 2025, more than 53,000 people died in Canada from opioid toxicity. In B.C., where opioid toxicity deaths have been declared a public health emergency, the Coroner’s Service determined that 35 per cent of victims of opioid toxicity between August 2011 and July 2021 were employed at the time of their death.
A study by University of Alberta researchers and a B.C. addictions medicine physician found that between 2016 and 2019, over two thirds of the victims of opioid toxicity in Canada had held employment at some point in the five years prior to their death. Those working in the construction, trades, and transportation industries – where work is physically demanding and injuries are common – have experienced the highest rate of opioid overdose deaths. Workers denied paid sick leave sometimes seek opioids to treat their pain quickly so they can keep working. Employers then punish them for doing so.
More harm than good
In addition to the intrusive nature of the program into which Nola was coerced, its financial cost was steep. Nola had to sign up with a privately-operated medical monitoring company that tracked her compliance with drug testing and mandated 12-step meetings – which Nola calls “forced spirituality.” While her union paid the monthly fee charged by the monitoring company for the first two years, subsequent years were partially covered by Nola and partially by her employer. According to Chapnick’s research, the bill from a medical monitoring company can reach $51,000 over five years.
Nola had to attend a private pay treatment centre in Ontario – these typically cost the B.C. Medical Services Plan up to $25,000 – which she says didn’t use a trauma-informed approach.
“I was basically in withdrawal the whole time [from being cut off from Suboxone and anti-anxiety medication] and having extreme [post-traumatic stress disorder] symptoms. The whole experience was terrifying.”
Nola asked her employer if she could get a second medical opinion about her return-to-work conditions and was refused.
Based on Stigma
Charlotte Ross, professor emeritus at Douglas College’s faculty of nursing program, has conducted extensive research on a monitoring program for nurses in an unidentified Canadian province.
Ross and her co-authors note that workplace monitoring programs were established in the 1980s when the standard treatment for substance use was abstinence and 12-step programs. Having gone to nursing school in that decade, that’s the treatment she herself was taught. She says, “The majority of employers and workplace and professional regulatory policies that I have seen have not evolved to reflect current evidence and norms of practice since that time. They are stuck in these historical ideologies.”
Although Ross’s research focused specifically on workplace substance use policies for nurses, these findings have broader applicability.
In 2018, the Canadian Centre on Substance Use and Addiction published a Review of Workplace Substance Use Policies in Canada which reveals how workers’ substance use is policed across Canadian industries – from construction and mining to oil and gas; longshore work; transportation; municipal services; and health care.
The report found that of the small percentage of employers who had comprehensive substance use policies, the majority mandated their workers into treatment if they were identified as having substance use issues, with nearly half also enforcing random drug testing after treatment. Additionally, nearly one in five of these employers admitted to firing workers who tested positive.
A paper commissioned by the Continuing Legal Education Society of B.C. and written by Chapnick entitled “Beyond the Label: Rethinking Workplace Substance Use Policies” concluded that employers unfairly single out workers who have been diagnosed with substance use disorder based on the misconception that they pose a unique and extraordinary risk to workplace safety.
However, there are many reasons that a person's abilities could be impaired at work including sleep deprivation, fatigue, stress, injury, temporary disability, and substance use. Substance use is the cause of only a small percentage of workplace impairment.
Monitoring programs conflate a medical diagnosis (substance use disorder) with a person’s ability to safely work.
In “Beyond the Label,” Chapnick concluded that monitoring programs operate under the misconception that a diagnosis of substance use disorder always indicates a chronic and progressive condition, and that, if left untreated, the individual will inevitably come to work impaired and cause harm.
In reality, people experience substance use challenges in diverse ways, and complete abstinence is not a prerequisite for effective functioning. These challenges are often temporary, and most people recover without formal treatment or total abstinence. For those who do seek treatment, a variety of effective approaches exist, and having choice in treatment is associated with better outcomes.
Monitoring programs purport to prevent and detect impairment in the workplace. However, in a paper titled “Test ’Em All: Drug Testing Law & Policy,” Chapnick argues a urine drug test cannot detect when a substance was used, how much or how often that substance is used, or if a worker is or ever has been impaired at work.
Ross’ research reveals that monitoring contracts impose one-size-fits-all conditions on workers’ continued employment regardless of the severity of a worker’s substance use challenge and regardless of whether their substance use ever impacted the workplace.
In the case of nursing, Ross says, “Monitoring programs enforce a nurse’s compliance to a standardized regime and do not assess their fitness to work using robust metrics or their actual health outcomes [...] They're not resting, recuperating, relaxing, and recovering. They're running around meeting these requirements that are not necessarily helpful to their individual recovery.”
Employer reliance on monitoring programs also ignores that protection against impairment on the job is already baked into workplace governance. The Canadian Centre for Occupational Health and Safety guidelines, for example, state that employers can reassign workers if their ability to work is impaired in a number of ways.
“If somebody is showing up and they have alcohol on their breath and they’re slurring their words and they don’t appear to be competent or behaving in a safe way, you can describe that behaviour and make a judgement as a supervisor and pull that person off duty. As an example, as a supervisor I’ve done the same thing with someone who couldn’t practise safely because of a terrible migraine,” Ross says.
She says that if impairment is an ongoing concern, an occupational health and safety expert can assess a worker's ability to safely perform their duties. They can also assess whether working conditions are contributing to workers developing substance use challenges and hindering their recovery.
WESUP believes that an employer's only legitimate interest should be whether or not an employee's ability to work is impaired while actively on the job. Seeking to control workers’ health-care decisions and behaviour outside of work intrudes into workers’ personal lives, and violates their rights to bodily integrity, privacy, and consent.
Undermining public health care
For two years, Nola followed the terms of the monitoring contract and never had a positive drug test. She had been back at work for a year when her employer signed a deal with a different monitoring company and she was required to switch. The new company was owned by the first IME doctor who had assessed her.
Instantly, Nola was forced off work again for six months by the new monitoring company and had to undergo an assessment with a second IME doctor assigned to her. This doctor said she had breached her contract by using Tramadol – a pain medication – prescribed by her family doctor for chronic pain and approved by the previous monitoring company. After the new monitoring company reported this to her regulatory body, they slapped additional time onto the contract for a total of over five years of monitoring. Without Tramadol, her chronic pain returned. She paid thousands of dollars for alternative medicine to try to reduce her pain, but it was constant. At times, she couldn’t get out of bed and was experiencing suicidal thoughts.
“How is it ethical that I’m being monitored by a company owned by the doctor who [initially] recommended the monitoring? How can she be unbiased in her recommendations?” Nola asks.
Researchers from the B.C. Centre on Substance Use, B.C. Nurses Union, Douglas College, University of Victoria, and RainCity Housing raised red flags about this type of conflict of interest in a report that was made public in a 2021 CBC investigative story. The reporting revealed that the small group of physicians used for IMEs in B.C. make recommendations which may include referring workers to medical monitoring companies they themselves own.
A U.S. Institute of Medicine report on conflict of interest in medical practice concluded that when physicians have financial incentives – including ownership in referral facilities – it can have a dramatic impact on the medical care they recommend, including unnecessary services which can harm patients. WESUP argues that IME doctors are doing exactly that to workers.
DJ Larkin is a lawyer and the executive director of the Canadian Drug Policy Coalition (CDPC). The organization advocates for drug laws, policies, and institutional practices that are based on evidence, human rights, social inclusion, and public health. Larkin considers monitoring programs to meet the criteria of “coercive care” and says the programs can cause significant harm, come with high costs, and do more to control people rather than help them.
“Forced treatment and monitoring do not meet the minimum standards we should expect for care: they harm workers. Our goal should be to ensure a safe workplace for all, not to line the pockets of private healthcare companies benefitting from these punitive policies. If a worker’s substance use impacts the workplace, the employer can implement reasonable, proportionate, and evidence-based policies to ensure workplace safety."
Monitoring programs funnel workers into the for-profit health-care system. The IME doctors work in private practice and the treatment centres are for-profit, as are the monitoring companies. The cost of five years of monitoring including IMEs and treatment can reach close to $80,000 for one worker. Employees can sometimes be stuck paying large percentages of this out of their own pockets. Employers that implement monitoring programs are supporting for-profit health care, allowing the industry to grow and undermining the public health care system.
A better approach
AVI Health & Community Services, an employer in Victoria, has created a “Ready to Work Policy” – one rooted in evidence and compassion.
Kim Toombs, senior director at AVI says, “AVI’s policy focuses on employees’ behaviour in the workplace and ability to perform their job duties. If an employee is not ready to safely work for any reason, we don't allow them to work. We treat our employees with compassion and understanding and offer voluntary support. We don't interfere with their private lives or personal health-care decisions. The purpose of the policy is to keep the workplace safe, and support employees’ well-being and ongoing employment.”
AVI’s policy reflects the findings of Chapnick’s “Test ’Em All” paper commissioned by the Continuing Legal Education Society of B.C., which concluded that the best way for employers to ensure the safety of everyone in the workplace is by managing workplace hazards, providing workers with appropriate supervision, and clearly communicating and enforcing safety rules.
When it comes to monitoring as a form of health care, Ross says it is not applied in ways that are consistent with many ethical standards that are applied to other situations in health care. For nurses, Ross says this means being “denied quality and ethical health care which includes consent, choice, individualized collaborative care, harm reduction, trauma-informed care, and medication options including Opioid Agonist Therapies.”
It’s been three years since Nola finished her five years of monitoring and she is still traumatized by the experience.
“This was the most damaging, invasive, and triggering experience. The only thing that was putting me at risk for relapse and overdose or going to the street for drugs or committing su***de was what they were doing to me […] Every time I questioned the program – about the lack of an evidence-based and trauma-informed approach – it was just like, ‘this is how it is; you do it, or you get fired.’”
“The whole program [seems] based on this belief that people who use drugs are dangerous and can’t be trusted,” Nola says.
Ross says a fear of being forced into a monitoring program or losing their job prevents workers from seeking help for substance use challenges. She says there’s no data available about how many people drop out of workplace monitoring programs and leave their careers or die of overdose or su***de.
Nola continues to abstain from alcohol. She can now effectively manage her chronic pain with prescription ketamine and can use cannabis to help her sleep, som**hing she wasn’t allowed to do while being monitored. She uses opioids prescribed by her doctor only if her pain is unbearable because she doesn’t want to become addicted again. She’s receiving trauma therapy, som**hing she was never offered by her employer. One of her therapy goals is overcoming the trauma she experienced in the monitoring program.
Nola says that even years after completing the monitoring contact she continued to be subjected to constant surveillance in the workplace. She was accused of using drugs at work, investigated, and the accusations found to be unsubstantiated. She says the way she has been treated is because of the stigma against people who use substances.
As a result, she has left the nursing profession. “It was too much. I could never get out from under the program. After 12 years of serving my community, I had no credibility.”
A call to the labour movement
Labour unions in Canada have always fought for workers’ health and safety, and must continue to do so by protecting workers from harmful drug policy on a systemic level.
WESUP is raising awareness that labour unions have the power and responsibility to take action.
Labour unions should be negotiating for collective agreements that don’t allow for mandated abstinence, random drug testing or coercive treatment; negotiating for health benefits packages that offer a full spectrum of physical and mental health-care services grounded in harm reduction principles – ones that all employees can access voluntarily and confidentially; and advocating to make overdose response kits and training available in all workplaces.
Outside of the workplace, unions should also help protect workers by advocating for supervised consumption sites, drug checking services, a legalized and regulated drug supply, an end to prohibitionist drug policy, and the integration of addiction and mental health services into Canada’s publicly funded and regulated universal health-care system.
The labour movement is uniquely positioned to revolutionize drug policy. Historically, revolutions happen when the masses demand change and refuse to back down.
The war on drugs is a war on workers and the labour movement must fight back.
This is a call to action.
*Nola is a pseudonym
