Suboxone

CONFESSIONS OF A DOUBLE AGENT-

MY SECRET LIFE AS A MEDICATION ASSISTED TREATMENT (M.A.T) THERAPIST

I’m sure we can find people out there who know much, much more about medication assisted treatment than I do. There are people out there who understand the technical end of medication assisted treatment better than I do. What do I mean by the technical end? The neurobiological process involved with a partial agonist versus a full agonist. The process of initiating the medication, the appropriate dosages, what you can expect in regards to withdrawal symptoms.

There are certainly people who understand more about medication assisted treatment than I do in terms of running a clinic. This includes all the rules and regulations. How many clients can a doctor have on their roster? What are the rules regarding “counseling” and drug testing?

There are people who understand insurance reimbursement and the business model better than I do. There are people who know more about the status of prescribers  and why we seem to have a shortage. There are also people who have personally been involved with medication assisted treatment and they know more about the lived experience of M.A.T. than I do.

However, there are some areas that I understand more than anyone on the face of the planet:

I know what it is like to be an “independent” therapist who specialized in working with people on medication assisted treatment within a recovery culture that was very hostile toward those on M.A.T. And I did in complete secret and silence.

From 2007 thru 2011 I worked with hundreds of M.A.T clients in western Pennsylvania as the opioid epidemic raged. Suboxone was being prescribed at a high rate and it was, relatively speaking, a new phenomenon. These patients were absolutely marginalized by the larger recovery community.

Truth is they were also marginalized by “traditional” treatment providers. I was an active member of Narcotics Anonymous at that time. NA dismissed suboxone as “being high”. They were not welcomed at NA meetings.

This short quote from NA will give you an idea of this problem.

“Our program of recovery begins with abstinence from all drugs, including alcohol.”

Check out this PDF from NA – Narcotics Anonymous and Persons Receiving Medication-Assisted Treatment

I remember watching this unfold and thinking “this isn’t right”.
But I did not have the courage to speak up.

I was too enmeshed in the group. I wanted the approval of people “ahead of me on the path” and had not yet matured in my recovery. I sat silently as people on Suboxone dealt with the stigma within the stigma. It may be slightly better now. This was 10 years ago. It was ugly, it was brutal.

At that time, the common practice was “dose and go”. Physicians from a wide variety of backgrounds were getting “certified” as buprenorphine providers via a 9-hour online training platform.

There were some stipulations regarding counseling but none of the patients were getting any real coaching or support. This is still the case in many practices today, however, I think it has improved. 10 years-ago it was truly the wild west and most patients were getting their script and nothing else.

Of course, this presented massive problems.

As I stated above, I was an active member of Narcotics Anonymous at that time. Attending daily meetings, sponsoring people, chairing home groups. This was western Pennsylvania where the heroin epidemic has been raging for 15 plus years.

There were countless people showing up at these meetings on Suboxone. And the honest truth about the situation is they were completely marginalized and shamed out of the rooms. I am ashamed of how I conducted myself at that time. I would not participate in the bullying that went on around Suboxone.

I didn’t directly make comments about Suboxone being a crutch. I didn’t make comments like “they aren’t really clean”. However, I would sit by silently.

You see, all organizations or groups operate via social following principles. People fall into line and adhere to the group norms. We do this because we want to be accepted and we want to fit in. Evolutionary psychologists tell us that it is a survival mechanism.

As we evolved and we survived a nasty world it was essential that we be part of a tribe. Being a loner or going against the crowd equaled death. Back then it was physical safety we sought via compliance and group think. Today we follow the tribe to ensure psychological safety. Either way it is hard-wired into our thinking.

That’s not an excuse for my behavior, but it is an explanation.

Keep the reality of social following in mind when you consider what it must be like to be a person seeking recovery via medication assisted treatment attending a recovery support group.

Imagine standing outside smoking a cigarette (which is basically medication assisted treatment in its own right) while your “peers” make comments about people on suboxone. The official literature evens states: we are a program of complete abstinence. People would run from the rooms; and we all know how dangerous it is to try and “do recovery” without supportive people in your life.

NOTE: IT IS RIGHT ABOUT NOW THAT SOMEONE BECOMES OFFENDED BECAUSE THEY HAVE SPONSORED PEOPLE ON SUBOXONE OR THEY HAVE BEEN PART OF A WELCOMING RECOVERY GROUP. I WANT TO ACKNOWLEDGE THAT THERE ARE PEOPLE WHO ARE OPEN TO M.A.T. HOWEVER, IN THE INTEREST OF RIGOROUS HONESTY-WE NEED TO ACKNOWLEDGE THAT IN MAJORITY OF CASES YOU ARE A SECOND-CLASS CITIZEN IF YOU ARE ON M.A.T. AND IT WAS 100 TIMES WORSE 10 YEARS AGO….

With this culture firmly entrenched around me I became more and more distraught about what I was seeing where M.A.T. was concerned.

And then people started dying; at alarming rates.

Now at this time I was a therapist working professionally in the clinical treatment realm. I remember thinking: “OK the recovery community is not going to embrace this. Certainly, the professional community would”.

However, as I explored M.A.T. with traditional treatment programs and outpatient therapists I quickly realized no one was working with these patients.

That’s when I went undercover…

When I decided to start a private practice specializing in M.A.T. It was small initially but steadily grew and I became an expert on working one to one with these clients. However, the entire time I kept this quiet. I never openly discussed this with my support group. I never advertised. I never promoted it among my professional colleagues.

HERE’S THE THING: THE STIGMA AROUND M.A.T. WAS SO STRONG THAT I WAS AFRAID TO EVEN ADMIT I WAS TRYING TO HELP “THEM”.

Now, 10 years later, I could care less now what fellow professionals think about me as I try and help people on M.A.T. I still hear professionals say things like “suboxone blocks the sunlight of the spirit”. Now, instead of being intimidated, I am appalled and stunned that these people are permitted to practice. I cannot believe this type of thinking passes the test in terms of treatment or healthcare.

I have also developed a healthier perspective on the integration of M.A.T. into the larger recovery community. First of all, I think things have improved somewhat in terms of groups embracing M.A.T. It is different in 2017 than it was in 2007. Although, the truth remains that the official company line in most groups is “abstinence” only.

In the recovery rooms you will be accepted on M.A.T. if it is “temporary” and your goal is to get off the medication in the near future. It’s more difficult if your treatment plan includes long term medication maintenance.

More importantly, It is clear that self-help groups bear no burden in adjusting the thinking around medication assisted treatment. These groups are voluntary, free, mutual support programs. They do not charge health insurance. They do not promote themselves as healthcare. Therefore, they have no ethical responsibility to adjust the message.

I may not agree with the way M.A.T. is handled but it is the group’s prerogative.

The burden falls on professional recovery services, treatment and healthcare in general. Treatment and recovery providers who refuse to adopt medication assisted treatment as a viable practice must rethink their philosophy. Treatment providers who refuse to include M.A.T. in their practice should not be eligible to treat opioid use disorders.

These organizations should be denied payment or licensure to work with opioid use disorders; they can stick to alcohol and other drugs but they are a major part of the problem where opioids are concerned.

We must find a way to professionally support these folks and acknowledge how difficult it is to follow traditional pathways. We must bridge the gap through recovery coaching. We need to be there when these people are told “you aren’t clean” so that we can talk them through the reality of the situation. We need to pick up the pieces for the dose and go doctors that are still up and running in many communities.

As for our organization, FAVOR Greenville, we welcome you with open arms if you are on M.A.T.

You are in recovery if you say you are in recovery.

Your involvement with our organization comes with zero strings and no hidden agenda. We will help you identify your personal recovery plan and your personal pathway to recovery; with or without medication.
We don’t care how you get better…we just want to see you get better. Let us help.