Jennifer Michaels, M.D.: Fearful and flourishing in Berkshire County

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Tanya's five-year-old son Aiden cruises around my office, intermittently "biting" us with his dinosaur. Tanya (an alias) gently tousles his hair as she worries: "If they found out, I'll be exiled. You wouldn't believe what they say about our patients on suboxone. I'm really living a double life".

Tanya doubles as a nurse in a medical office and a member of a secret club. Members represent a diverse swath of individuals, all contributing to our community: construction workers, healthcare professionals, students, teachers, clerks, house cleaners. They all share a history of addiction to opioid pills and/or heroin. And they all choose to take medication as part of their treatment.

Struggles

Tanya had struggled on the path to suboxone and its resulting stability. Two inpatient detoxification attempts preceded months of intense cravings and subsequent relapses on heroin. After a near-fatal overdose, Tanya decided she needed additional help, so she started suboxone. She expected tormenting withdrawals, but found none. Even after eight years, Tanya tears up when discussing her sobriety: "I'm not craving. I'm not high. I just feel normal."

Sadly, Tanya pays a price for feeling "normal." Medications such as buprenorphine (Suboxone, Zubsolv, Sublocade and others), methadone and naltrexone (Vivitrol) represent some of the most stigmatized, misunderstood treatments for any medical disease. Common misconceptions deem these medications a "crutch" or "legal high". Some believe that only a medication-free, abstinent person is really "clean;" everyone else — "dirty." These uninformed assumptions and stigmatizing terms sustain an antiquated view that ignores 21st-century scientific evidence.

Here are the facts:

Every 11 minutes someone in the United States dies from an opioid overdose.

Tanya was one of the lucky ones. Heroin is deadlier than ever now that street heroin is routinely laced with fentanyl, a synthetic opioid fifty-times more potent than heroin.

Only about 20 percent of people needing treatment for opioid addiction currently receive treatment.

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Many Americans lack this critical access and are forced to drive three hours or more for medication. Tanya and others in our community are more fortunate. Berkshire Medical Center, the Brien Center, Spectrum Health Systems and other community programs offer medication for opioid withdrawal and craving.

Less than 25 percent of all publicly funded addiction treatment programs in the United States offer medication to treat opioid use disorders.

Double standard

We apply an odious double standard to addiction treatment. Imagine having diabetes and being told that your treatment program does not believe in insulin. Imagine having heart disease and being told that taking medication is "cheating", and that only people who lose weight and eat the right food are truly in recovery. Diabetes, addiction and heart disease are all chronic diseases Some people successfully alter the course of these diseases solely with lifestyle and behavioral changes. But many need more. Medication is not a panacea, and some continue to relapse even with medication treatment. But for Tanya and many others medication is lifesaving.

Those taking medication for opioid addiction experience a fifty percent (or more) increased survival rate.

Furthermore, people taking medication to treat opioid addiction are more likely to stay in treatment, find employment, and improve their physical and emotional health. Tanya's recovery followed this course. Once sober, she completed her education, married and started a family. Inspired by the help she received, Tanya became a nurse to help others and to work with those struggling with her same addiction.

The World Health Organization, Federal Drug Administration, National Institute of Drug Abuse, the United States Surgeon General all recognize and support the treatment of opioid addiction with medication.

Tanya is living proof of the wisdom to this approach, and she directly credits suboxone for halting the chaos of her addiction by breaking the craving-relapse cycle. Tanya also credits therapy and community self-help meetings for helping her gain meaningful insights, build a sober network and learn how to live as a sober person. Medication does not replace but rather facilitates engagement in psychosocial therapies and self-help groups.

Appointments with Tanya and others like her consistently fill me with hope and awe. The transformation from crippling addiction to sustained recovery is best described as rebirth into a life of meaning, direction and gratitude. For now, visits with Tanya and others are tinged with sadness, as the intense stigma attached to their disease and treatment choices silences them. For now, there are no ribbons, no role models, no races. They are our neighbors, relatives, co-workers, all fearful and flourishing in the Berkshires.

Jennifer Michaels, M.D. is the Medical Director of the Brien Center and Attending Psychiatrist at Berkshire Medical Center. She is dual board certified in addiction and general psychiatry.


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