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In Philly’s recovery community, a bias against those taking medication to treat opioid addiction

Steve Silbert and Megan McAllister and their family. April 17, 2018 Category: FeatureFeaturedLongPurpose


Correction: Marti Hottenstein does not currently take methadone, as previously stated. (4/18, 9:50 a.m.)
When Megan McAllister’s boyfriend, Steve Silbert, announced 30 days of sobriety at a Narcotics Anonymous (NA) meeting, the room was quiet.

The tradition of announcing anniversaries at 12-step meetings is typically celebrated with applause, but McAllister said the couple was only met with a terse sendoff: “Come back when you’re clean.”

Silbert and McAllister had previously shared that they were taking methadone, a medication-assisted treatment (MAT) for people with opioid use disorder. People who are on MAT often face stigma in traditional 12-step groups, such as NA or Alcoholics Anonymous (AA).

To provide judgment-free spaces, meetings based off the 12-step model have been started for people who take medications such as methadone, extended-release naltrexone (Vivitrol) and buprenorphine (Suboxone).

McAllister, who is a certified recovery specialist at Kensington-based health nonprofit Prevention Point, began chairing a weekly medication-assisted recovery meeting at St. Mark’s Church on Frankford Avenue near Sellers Street about three months ago. Her co-worker Wilfredo Laboy started the meeting, but encouraged her to take over since he was not on MAT.

She said about 30 people attend the weekly Wednesday evening meetings.

“When you come [to other 12-step meetings] and you’re on methadone or Suboxone, you’re treated differently,” said McAllister, who is in long-term recovery. “It didn’t make sense because I’m taking a prescribed medication every day, yes, but it’s helping me. It’s not a crutch. … It’s an extra step that I’m taking to stay clean.”

From our Partners

What is MAT?

MAT is the use of “behavioral therapy and medications to treat substance use disorders,” according to the Substance Abuse and Mental Health Administration.

Dr. Kristin Van Zant is the medical director of behavioral health services at Public Health Management Corporation, a nonprofit that manages several local health centers. She said each patient should consider the differences between methadone, Suboxone and Vivitrol before beginning treatment.

She noted that all of the medications share one crucial similarity: helping people break up the cycle of craving and using opioids.

All of the medications share one crucial similarity: helping people break up the cycle of craving and using opioids.

Methadone is the “most similar to heroin” and highly regulated, Van Zant said. Those who choose this treatment must meet certain requirements, such as visiting a clinic every day to receive the medication, attending a certain number of weekly group meetings and communicating with a counselor. Suboxone is weaker than methadone and can be prescribed by physicians, she added.

Vivitrol, which is taken monthly as shots, can also be prescribed by a physician, but the patient must not have used any opioids for at least 10 to 14 days at risk of an “extremely unpleasant” withdrawal, Van Zant said.

In 2017, Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services made it mandatory for all forms of MAT to be available in opioid treatment programs, according to a report by The Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia released in response to the city’s opioid addiction epidemic. It also increased the availability of buprenorphine from 100 to 1,000 slots in the city.

Despite city officials promoting MAT as a treatment option, people like McAllister and Steve still feel unwelcome in some 12-step meetings, which Van Zant said could be a vital form of peer support for someone entering recovery.

“It is very dangerous when people take the view, ‘Don’t be on medication-assisted treatment,'” Van Zant said. “We know that [addiction] is a biological condition. … It isn’t something that therapy is going to necessarily talk away.”

‘I know how turning somebody away can kill them’

Jolynn Twilley has been in and out of methadone clinics since 2005, but said McAllister’s weekly meeting — which she has been attending for about two months — is the first one meant for people on MAT that she knows of. She added that she regularly attends group meetings at her methadone clinic, but even there, she rarely discusses MAT.

“I was super excited about it,” said Twilley, who lives in a Kensington recovery house. “I hadn’t really got around that much to find one that I liked or find someone I related to to be a sponsor. This is super exciting for me that I can make this my home group.”

"The stigma on addicts is bad enough, but to have a stigma on people taking medication is even worse."
Megan McAllister

McAllister and other members of the meeting rewrote the 12 steps and traditions used in groups like AA and NA to include language inclusive of people who are taking MAT, she said.

Other members also help by being the chair, secretary, treasurer, clean-up crew or coffeemaker for the meeting — all facets of other 12-step groups that help build self-esteem, she said.

McAllister uses a Facebook group and flyers to spread the word about the meeting. She usually encourages her clients at Prevention Point to come, too, she said.

“The stigma on addicts is bad enough, but to have a stigma on people taking medication is even worse,” McAllister said. “Let us do what we need to do in our daily life, just like what you do in your daily life. … All 12-step programs need to be aware that all of us are equal.”

Marti Hottenstein started the How to Save a Life Foundation after her 24-year-old son Karl was turned away from an in-patient treatment facility in 2006 and, six weeks later, died of an overdose.

She vowed to help at least one person get into recovery on June 21 — his birthday — every year. Since 2007, she’s helped more than 5,000 people enter recovery through initiatives at the foundation like treatment scholarships.

By May, she plans to open a clubhouse for people who are taking MAT in Montgomery County, where she will also host MAT-specific, 12-step meetings.

“I know how turning somebody away can kill them,” said Hottenstein, who has previously taken a form of MAT and will celebrate her 31st anniversary of sobriety next month. “We need to start meeting people where they’re at, not where we want them to be.”

McAllister said Hottenstein’s center opening in Montgomery County shows stigma against MAT exists on a widespread level, and it needs to be addressed.

Methadone has helped her be a mother to her two children, maintain a long-term, healthy relationship and act on her “deep love” to help other people, McAllister said.

“Some people like to say [methadone] is liquid handcuffs,” she said. “I look at it as setting me free. When I take my medicine, I feel that I’m able to function as a successful member of society.”

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