Medication-assisted therapy (MAT) for drug addiction — that is, methadone or Suboxone — is a proven way to help addicts stay clean. Narcotics Anonymous programs offer community support that helps addicts stay clean, but turns away people who are using medication to aid their recovery. Why, if their goals are the same?

The misconception stems from the fact that most medications for treating addiction, like Suboxone and methadone, are opioid-based. With the correct prescription, an addict’s compulsive behavior, loss of control, constant cravings, and other hallmarks of addiction will usually vanish. But if you take too much, you will get high. The idea that MAT is just a replacement drug has been debunked countless times by medical organizations, including the U.S. Department of Health and Human Services (HHS).

Nonetheless, Michael has been told that he is still a junkie, not only by people in the 12 Step meetings he used to go to, but also by friends: “They look at you like you are still using, that you are not sober, that you are basically still living the life of a drug addict, when you are not.” Michael has come to terms with the fact that he will probably have to take methadone for the rest of his life. He hates the stigma associated with his medicine, but he knows that he needs it to function.

Narcotics Anonymous requires complete detox, from all substances, before a person can enter the program. In The New Republic, Katrine Jo Anderson and Cecile Maria Kallestrup look at whether this stance actually exacerbates the opioid crisis — it not only keeps people apart from a potentially critical source of community support, but can be physically dangerous.

But what is accepted with grim resignation at the detox ward is a source of deep dismay for medical experts. “Detox without MAT is potentially dangerous,” said Bachaar Arnaout, an assistant professor of psychiatry at Yale School of Medicine. “An overwhelmingly majority of people end up relapsing after detox. It’s a gamble with lives.”

When patients go through detox, their tolerance decreases drastically. If they fall off the wagon and take the dose of opioids they were used to, or even a lower dose, this can be enough to shut down vital body functions. This is especially the case today, Arnaout said, because the opioid epidemic is largely driven by fentanyl—an opioid up to 50 times more potent than heroin.

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