When Jenna Johnson — a mom, a singer, a professional cookie decorator — underwent blood work for hepatitis C treatment, two lab nurses asked her, “How did you get hep C so young?”
Jenna answered honestly: She’d been an IV heroin user. But now she was in recovery, living with her family instead of on the streets, pulling her life together with the help of Suboxone.
“They were like, ‘Oh, so you’re not really clean,’” recalls Jenna, 34, a patient at Ideal Option. “‘Don’t you think that’s just substituting one drug for another?’”
Jenna responded: “No, I’m here getting blood work. I’m showing you my social security card, which I wouldn’t have even had when I was using heroin. I’m about to deliver cookies to people who paid for them. I wouldn’t have this life if I wasn’t on Suboxone.”
When you’re working to overcome opioid use disorder (OUD), nothing is less helpful than society’s judgment. Yet OUD patients routinely face a double dose of stigma: They’re demeaned for their addiction — “You’re just a junkie, you suck at life,” is the message Jenna absorbed — and for taking medication such as Suboxone.
Ironically, among the worst offenders on both fronts are the doctors and nurses employed to care for them.
“In the medical community, we have not treated these folks well,” says Jeff Allgaier, M.D., chief medical officer at Ideal Option. “We’ve called them ‘drug seekers,’ ‘junkies,’ ‘another one of those patients.’ We’ve considered addiction a moral failing, not a disease. This attitude continues to be pervasive in healthcare.”
What’s more, some healthcare professionals — in addition to drug courts, corrections officers, and even some 12-step and inpatient rehab programs — label Suboxone a “crutch,” despite overwhelming evidence that the medication suppresses withdrawal and cravings, lowers the odds of relapse, and saves lives.
The moralizing only keeps patients from pursuing sobriety. “If you’re told enough times that you’re a bad person and addiction is your fault, eventually you’ll come to believe that,” Dr. Allgaier notes. “So, people feel undeserving of treatment.”
Yet even in the face of judgment and stigma, people with OUD can overcome addiction. It’s happening every day at Ideal Option, where patients like Jenna feel welcomed and encouraged, no matter what they face outside the building.
“When I go to my appointments, they ask, ‘How are your kids? How’s your mom? How’d your hand surgery go?” says Jenna, now 20 months into recovery. “They’re always super proud of us. It feels amazing when people treat you with integrity and trust.”
Battling the Stigma of Addiction
That’s not how Shante Jackson was treated during her first visit with a new primary-care doctor.
“I was telling her my medical history, including my addiction, and she just gave me this look,” recalls Shante, an Ideal Option patient who’d recently moved from Louisiana to Washington. “As much as she tried to hide it, I could see the disgust on her face.”
At a second visit, Shante brought up her chronic hip condition, asking whether she might be a candidate for a cortisol injection or, eventually, a hip replacement. The doctor said, “You know, we’re not giving you any medication.”
“I was like: I didn’t come here for medication,” Shante recalls. “I came here to talk about my hip.”
Amber Knight, also an Ideal Option patient, knows the feeling of being “profiled.” It used to happen often when she was homeless and using drugs.
“When you’d go into a grocery store, you’d be followed, even though you’re just going to use the restroom, not to steal anything,” says Amber. “People just look you up and down like you’re dirty. They don’t consider that when people are addicted, it’s because they don’t want to feel or don’t know how to handle their emotions.”
The looks, the whispering, the snap judgments — “It makes you feel like you’re worthless, like you’re an outcast,” says Amber. “It makes you want to use even more.”
For years, that’s what Amber did. Addicted to heroin and meth, she was living in the bushes behind an apartment complex, estranged from her son and daughter, periodically landing in jail, wondering if life was worth living.
Eventually, amidst all the judgment, came a voice of encouragement — from a childhood friend who found her on Facebook and is now her husband. With his support, Amber stopped using drugs and landed a job at a thrift store, only to relapse multiple times.
“One day I woke up just tired of being sick and tired,” Amber recalls. “I went to my bosses and told them, ‘I need to get help.’ They said, ‘You go take care of yourself, and you’ll still have your job.’”
Amber got lucky. That kind of encouragement can be hard to come by, which is why the best addiction providers are so intent on offering emotional support along with medical treatment. They know walking through the door is just the first step toward recovery.
“The stigma makes patients feel guilty and shameful and makes them hide the rest of their feelings, so they can’t fully embrace their recovery,” says Shawna Laursen, M.D., medical director at Ideal Option. “There’s always this big secret you can’t share, and you can’t be completely in your recovery.”
As Dr. Laursen notes, “It’s hard to tell your new boss, ‘I have to go to a meeting for my addiction.’”
Eventually, Ideal Option providers hope, the stigma of addiction will disappear, all employers will support folks in recovery, and drug addict will be replaced by the more humane and appropriate term: “person with substance use disorder.”
Eventually, our culture will recognize, as Shante says, “Just because you’re an addict, doesn’t mean you’re not a person. Some of the smartest, most talented people have experienced addiction.”
But our culture is not there yet.
The Second Stigma: Taking Suboxone
No one belittles a smoker for using nicotine gum to quit tobacco. No one demeans a diabetes patient for relying on insulin to stay alive.
Yet Suboxone, a proven life-saving medication, comes with a heavy dose of judgment — from physicians, politicians, law enforcement, and the general public.
“When people find out you’re on Suboxone, you’re automatically labeled a junkie,” says Amber. “I’ve heard it from people at work.”
An acquaintance told Jenna that instead of taking Suboxone, she should combat opioid addiction “with the power of prayer.”
Judges, police, and corrections officers often pile on. “Lock ‘em up and throw away the key is the attitude,” says Dr. Allgaier. “They think you can incarcerate your way out of drug addiction.”
And while the 12-step community is coming around, stigma even surfaces at Alcoholics Anonymous or Narcotics Anonymous meetings. “You’ll have a few folks who’ve been able to get off of opioids without using medication,” says Dr. Allgaier, “and some think, ‘Because I was able to do it, you should all be able to. And if you can’t, you’re weak.’”
In reality, without medication fewer than 5% of people with OUD can recover, and virtually all patients will relapse within 30 days of leaving inpatient rehab or jail. Because of the unique way that opioids rewire the brain, many relapse on their first day out. Some overdose and die.
So, while counseling, group meetings, mental-health treatment, and other types of emotional support are critical for recovery, the rewired brain circuitry of an OUD patient requires medication.
“Without the right medication, the rest doesn’t matter,” Dr. Allgaier says.
In fact, Suboxone is so effective at suppressing withdrawal symptoms that he believes treating OUD without it is akin to medical malpractice.
“It’s the dinosaur way to do things, but doctors don’t change their ways very easily.”
Shante, who spent five years trying to overcome heroin addiction, knows the night-and-day difference between attempting to recover from OUD with and without medication.
“Suboxone is 1,000 times better than going cold turkey,” says Shante, who’s over a year sober and attends support-group meetings. “I didn’t have the diarrhea, the nausea, the throwing up, the shakes, and the quivers. I didn’t have any of that, and I don’t have any cravings.”
Shante dropped the primary-care doctor who gave her that look of “disgust” and surrounds herself with friends and medical providers who understand both addiction and Suboxone.
“It’s been amazing — I’m back to being myself,” says Shante, who is studying to become an addiction counselor. “I’ve never paid my own rent before, paid my car insurance, taken care of myself. Now that I am, it feels good. I have one year to go till I finish my bachelor’s degree. Just one year ago I wouldn’t have believed any of this could be possible.”