Grocery stores, highway exits, bars and parking lots. For many, these are places seen daily with no stress. For some patients in Cabin Creek Health System’s medically assisted treatment program, they are triggers that remind them of their struggles with drug use.
On Wednesday, at Cabin Creek’s Sissonville facility, five of these patients discussed these triggers during a group therapy session and learned tips from staff psychologist and MAT program manager Josh Carter on how to overcome them.
“Therapy is a major part of the recovery process, especially with MAT,” Carter said. “We’re trying to teach people how to be themselves again. There’s more than just one step in that.”
MAT is a type of recovery process that utilizes therapy in conjunction with medication, in this case buprenorphine, a “partial opioid agonist.” It’s dispensed under the brand name Suboxone, and works by stimulating the same brain receptors affected by opioids. Unlike opioids, though, buprenorphine does not produce any mental or physical impairments, Carter said.
Since Suboxone is partially composed of naloxone, a medication that counters the effects of opioid overdoses, there is a limit to how much it can affect the brain. It’s a practical way to curb withdrawal symptoms and cravings that can lead to chemical imbalances for those entering recovery.
Per the Substance Abuse and Mental Health Services Administration, MAT is considered a best practice for recovery. Still though, there is a stigma attached to it that can be hard to overcome.
Carter said most of this stigma — the misconception that MAT is “trading one drug for another” — is often promoted by people unfamiliar with the process, who have never witnessed its effects or the successes in patients.
On Wednesday, Kendal Ehrlich, deputy director of the Office of National Drug Control Policy, and Anne Hazlett, director of rural engagement at the ONDCP, visited Cabin Creek’s Sissonville facility to see how its MAT program works and to hear from patients on their successes — and challenges — in entering recovery.
Ehrlich said the visit manifested after she and Hazlett saw videos Cabin Creek produced to share testimonies of patients who have undergone MAT. In the videos, available on YouTube, patients spoke about regaining custody of their children, starting their own businesses, reconnecting with family and other successes, all while undergoing MAT.
“[Our visit was] to come and see the work being done, but also we recognize that some communities aren’t as strong on MAT, and, for the opiate user, it is really effective and really works,” Ehrlich said. “The [Trump] administration supports that, and we know the evidence is there, that this is a best practice.”
Cabin Creek started offering MAT at its Kanawha City facility in 2016, then in Sissonville in 2017, Dawes in 2018, and a program is scheduled to start in Clendenin in October.
For the first 90 days of treatment, patients in MAT programs at Cabin Creek attend weekly, three-hour appointments at the facility. There, they receive vital tests and drug screenings to ensure they haven’t used since the last appointment. If they have — relapses are part of recovery, Carter said — they are encouraged to be honest about it and the consequences will be “less severe.” If they are dishonest, they may be assigned to daily appointments at Cabin Creek or something more intensive.
After testing, they sit down to speak with Dr. Ryan Morrison, medical director for the MAT program, and discuss any difficulties they’ve had: side-effects, cravings or anything else they’ve experienced.
A group therapy session follows, where patients often attend a lesson led by Carter — Wednesday’s was on triggers — and talk to each other about any difficulties related to the topic.
Outside of the weekly appointments, patients must attend one hour of individual therapy with Carter and attend four 12-Step meetings monthly. After 90 days, 12-Step meetings can be subbed out for anything the patient identifies as therapeutic — exercise, volunteer work, church, etc. — and appointments at Cabin Creek switch to bi-weekly.
The successes of these programs — 27 patients have been sober for more than a year, and four for more than three years — did not come without its challenges, though.
When Cabin Creek looks at starting a MAT program in a community, staff members spend months beforehand attending meetings and inviting the public to learn more about the process. For Clendenin’s opening, next month, Carter and Lois Vance, addiction care coordinator at Cabin Creek, have already attended meetings with local stakeholders in hopes of getting them to be more accepting.
“The biggest barrier we have today is community stigma,” Carter said.
It can negatively impact the recovery process, where successful reintegration into a community is a key component to long-term sobriety. There’s also some prejudice against MAT programs in the recovery community. Some believe “cold-turkey,” total abstinence from drugs of any kind is the only way to achieve recovery.
But this process is different for everyone, Carter said. While some may utilize MAT when they’re first entering recovery to curb withdrawal, others may use Suboxone, long-term, to maintain their sobriety.
“If I have to be on it the rest of my life, I will,” one patient said at Wednesday’s group therapy session. “If that’s what it takes, it’s what I’ll do.”
And even with piles of peer-reviewed studies that say MAT and Suboxone treatments can save lives by decreasing the chance of overdoses and helping people healthily overcome and manage their addiction, there is still prejudice.
People in treatment will sometimes get pulled over while driving and be questioned by police about drug use. They’ll be honest and show them their valid prescriptions for Suboxone, and still receive tickets for driving under the influence, despite evidence that there is no impairment on the drug. Carter said he and others at Cabin Creek have helped patients navigate this, but it’s not easy, and the court system isn’t very forgiving.
Judges, he said, will order people to come off MAT or Suboxone treatments before allowing them to enter into drug court, which is often an alternative to spending time in jail. Child Protective Services workers will do the same before granting individuals custody of their children, Carter said, or they will try to use Suboxone as a reason for taking that custody away.
“It’s unfair and it’s not right,” Carter said. “These are people doing what they have to, in the safest way possible, to live their lives, and that’s essentially a punishment for them.”
The goal of Wednesday, as the federal officials watched care providers work with patients, was to “put a light on what works in recovery,” Carter said.
Ehrlich and Hazlett sat in on group therapy, asking questions of patients, like how long they’ve been sober, when did they start using drugs, what made them start using and what recovery looks like for them.
They heard uplifting, as well as heartbreaking stories, all of which were honest, personal examples of what addiction and recovery can look like.
The patients also gave testimonies to the MAT program: “If it wasn’t for this place or this program, we’d probably all be dead by now,” one said.
“It’s like, we’re learning to live again, to be adults and take care of ourselves. [Suboxone] has made that possible,” another shared.
“When I started here, it’s like I came out of a 15-year nightmare. I can be myself now. I hadn’t felt that in a long time,” another said.
Carter said that, when people resistant to the idea of MAT hear these stories and meet patients whose sobriety is partially a product of Suboxone, that’s the point where attitudes start to change.
“We can’t force them to accept,” he said. “We have to nudge them in the right direction and help them come to that conclusion themselves.”
It’s a form of “social sight,” and it’s one of the most effective ways to change people’s minds. Facts and research and science are easily defeated by emotions, no matter how unfounded, Carter said.
“These programs get a bad rap and, at the end of the day, that is what could be stopping people from getting help, from saving lives,” Carter said. “We invite everyone we can here to see what it really is, and that works. How can you say no when you see the successes we have, when you realize it changes lives?”
CORRECTION: An earlier version of this story misidentified Josh Carter. He is a staff psychologist at Cabin Creek Health Systems.