Veronica* slid into addiction slowly, increasingly drinking as a teen, and by the time college came around, she needed alcohol first thing in the morning to stop her hands from shaking. She says it escalated from there. For Veronica, addiction wasn’t a straight line, more like there were times she stopped entirely and others when there was a litany of drugs she used each day, including heroin and oxycodone. She quit multiple times, promising her family she was done, but it wasn’t until a close friend died in front of her, his arm hanging limply off the EMS gurney, that Veronica made a promise to herself for herself that she was going to get help. She turned a corner that day, driving to a nearby clinic where she started Medication-assisted treatment (MAT) and that, she says, “was all she wrote.” It’s not though, because six years later, Veronica is now an award-winning peer recovery coach, helping people navigate the challenges she faced. When asked what or who she credits for her recovery, Veronica doesn’t hesitate to say ongoing MAT and caring recovery coaches, but, she lowers her voice, her colleagues don’t know. She fears they wouldn’t accept her and she has good reason to think so. “There’s a lot of stigma within the recovery world and a belief that MAT is simply substituting one drug for another.” Veronica says in a recent discussion, a colleague said just that. “It’s startling because no one would say that about a person with a physical illness. Can you imagine if those in the medical field said to people with diabetes, ‘You shouldn’t use insulin as treatment.’ Well, that’s what’s happening in the field of recovery: people are often judged for using evidence-based medicine.”
The belief that MAT is exchanging one drug for another is not uncommon among the general population and even among physicians in the medical field. In May 2017, Dr. Tom Price, former Secretary of Health and Human Services, said, “If we’re just substituting one opioid for another, we’re not moving the dial much.” He faced immediate backlash from the medical and scientific community. Dr. Vivek Murthy, former Surgeon General of the United States, responded on Twitter that an abstinence-only approach isn’t backed by science, unlike MAT, which leads to better outcomes compared to behavioral treatment alone. Months later, in September, there appeared to be a shift in the federal government, with Dr. Scott Gottlieb, the FDA Commissioner at the time, saying that MAT “…is one of the major pillars of the federal response to the opioid epidemic in this country. He went on to say that MAT is an essential tool that has the potential to allow millions of Americans to regain control of their lives.
What’s surprising to Veronica isn’t that people in the general population don’t understand that MAT is an evidence-based practice but that those working in recovery are perpetuating misinformation. Medication-assisted treatment is a holistic approach for substance use disorders that combines counseling, behavioral therapy, and FDA-approved medication. She says that without MAT, she would likely be dead. “I would have continued using, or relapsed, unsure of what I was taking and the dosage. Heroin is no longer pure. It’s increasingly packed with other ingredients, many of them potentially lethal, like Fentanyl.” Veronica says that without treatment, she wouldn’t have been able to enter recovery because the pain associated with withdrawal is horrendous. It’s not just acute pain that’s problematic, but also precipitated withdrawal that happens months later, making each day unbearable. “People in recovery who haven’t had an opiate addiction often don’t understand what this type of withdrawal feels like in the short- and long-term. I think that’s why they aren’t sympathetic.”
Last year, Veronica’s 29-year-old half-sister died of endocarditis from intravenous drug use. Having shared similar struggles, Veronica believes she and her sister ended up on divergent paths because of money and stigma. “My sister went to the nearest clinic for two years, and she did well, but then she could no longer pay the $80 a week it costs to go to the clinic.” Her sister’s family refused to help with the fees because they thought taking Methadone would limit her job opportunities. “Because of stigma and fear of stigma, my sister is now in a mausoleum.”
Not sharing her treatment with colleagues has been taxing, and Veronica has struggled with whether she’s contributing to stigma by not telling her story. “I wonder about it every day. Am I living a lie? I don’t think they would accept me. From what I’ve heard them say, my guess is it would diminish their respect for me. If I make a human error, will they blame the fact that I’m on treatment, even if that doesn’t make sense?” Every week, Veronica goes into the clinic with her take-home bottles. The clinic fills them with medication for the next six days; on the seventh day, she goes back in to get her final dosage. She says it didn’t start off that way. At first, she had to go to the clinic daily, then, over time, the recovery team would give her medication to take home. After six years, she still goes to the clinic once a week. It makes Veronica nervous because there are weeks where it has been challenging to get to the clinic. For instance, last year, a massive storm was headed to her area. She lives out in the country, and snow would have made it impossible to get to the clinic. Veronica arranged to stay with family in town so that she wouldn’t risk missing the final dosage or filling her bottles for the next week. It’s these small changes that colleagues can notice, she says, and it makes her worried that they will figure it out; for example, wondering why she stayed with family instead of at home. The fact that she has to worry about it at all makes her angry. “I work in a recovery environment, but, ironically, I’m forced to hide my recovery and treatment from my colleagues. Stigma inside of an industry designed to help people recover and fight stigma is problematic.”
Veronica worries about how stigma affects others in recovery and how judgment toward those in recovery impacts people not quite there yet. At a recent team meeting, a colleague vented that Narcan—a medication that entirely or partially reverses an opioid overdose, including respiratory depression—enables people addicted to opioids, saying, “We’ll bring them back, and they will just use again.” “It made me so upset to hear someone in this role make a statement like that. We hope to keep people alive. We have many repeat clients, which is why the person was frustrated, but we want to be there for them when they take that long-lasting step into recovery. It took me multiple times to get there. What if people at the clinic had just given up on me? Where would I be? We want to do our best to create an environment for people to get the help they need when they need it.”
*Veronica is not the peer recovery coach’s real name. She has asked to remain anonymous.
This article was originally published on September 24, 2019.