Do You Perpetuate the Stigma?

by Eliza Player

This stigma of addiction keeps the drug user in the ancient realm of his moral failing, which is also exasperated by unchanging and archaic treatment models. Our treatment model is dominated by the 12-step model, which is a spiritual solution, relying on the connection with a Higher Power to find a treatment for addiction.  To claim that addiction is a spiritual problem that requires a spiritual solution, simply keeps addiction in the realm of moral failing.  Unfortunately, you hear this phrase often within 12-step groups.  If you had cancer, would you skirt all medical treatments, and simply rely on the power of prayer and your pastor’s blessing to cure you?  Of course not! But, yet our addiction treatment model is dominated by a spiritual solution, and too often evidence-based treatments are regarded as lesser options.  We all acknowledge today that addiction is a disease, but the old image of drug use being a moral problem remains embedded within society’s belief, keeping many from seeking a medical solution to this disease.  If you have diabetes, a doctor would not tell you to rely on your Higher Power to keep you alive, but he would look to evidence-based, scientifically proven, medical solutions.  Stigma is the only reason that addiction is not regarded the same as other diseases.


AATOD Conference 2013 + Dr. Kreek = Inspiration

AATOD Conference 2013 + Dr. Kreek = Inspiration

by Zac Talbott, BA, CMA

I just returned home from the 2013 National Conference of AATOD (American Association for the Treatment of Opioid Dependence, Inc.) in Philadelphia, Pennsylvania, and it was an energizing, inspiring and informative experience. I would be hard-pressed to even begin to disseminate all of the amazing information I absorbed, the wonderful people I met & the hope I now feel in a single blog entry, so I am going to focus here on one, specific and extremely life-changing experience with which I was blessed during the conference.


What Is Stigma?

by Eliza Player

In the last month, our Internet news sources have been running wild with stories of the mysterious drug Krokodil, complete with gory images of the flesh-eating damage that users experience.  Parents of drug users have been sent into a hysterical panic, wrought with worry and concern.  Former drug users have scoffed at these disgusting images as something that they were never desperate enough to do.  And everyone has been sharing these pictures and images with a nasty disgust.  I swear, I cannot get on Facebook for ten minutes without seeing another Krokodil post.  With each new story, my blood begins to boil a little more!


Behavioral Health Group (BHG) acquires Midsouth Treatment Center in Dyersburg, Tennessee

Behavioral Health Group (BHG) acquires Midsouth Treatment Center in Dyersburg, Tennessee

Behavioral Health Group (BHG) of Dallas, Texas has acquired the formerly independently-owned and operated Midsouth Treatment Center at 640 U.S. 51 in Dyersburg, Tennessee.

We noticed a change on the SAMHSA license of Midsouth Treatment Center to a local LLC of BHG a couple weeks ago, but it wasn't until yesterday that patients started contacting us letting us know the phones are now being answered as "BHG."  Several other NAMA-R TN members who are patients of this opioid treatment program in Dyersburg contacted us today after reporting for treatment to let us know that the program is now officially a BHG facility.  None of the patients we have heard from thus far were aware of or notified about this change in ownership until calling or reporting to the program this week.  It's unfortunate that patients weren't aware of, or involved in, this change in ownership and leadership.  There would be no opioid treatment programs without the patients who utilize their services.


When Facing An Epidemic, Advocacy Is Key (Part 1 of 2)

When Facing An Epidemic, Advocacy Is Key

Part 1 of 2

by Zac Talbott, BA, CMA, Director
NAMA Recovery of Tennessee
The Tennessee statewide and Northwestern Georgia Chapter of

"Just that you people who are involved in advocacy, keep up the work. I have seen 
changes come about because of people becoming involved. It is these who are the real heroes 
in all this. Without advocacy, changes will not come about within the present system." 
Dr. Vincent Dole

We are confronted with it on a nearly daily basis: prescription pain killer
and heroin addiction and abuse have risen as one of the top two causes of
unnatural death in the United States at an alarming rate. Newspapers,
television reporters, and online journals report on the rise in heroin use
and the opioid addiction and overdose epidemic more than any other
medical topic. Local governments and law enforcement agencies are
asking themselves and the citizenry, “What can we do?” as they see their
friends and family members swept up in this crisis as it plagues the


The 2013 "In My Own Words..." Essay Contest

Celebrate Recovery Month 2013

"In My Own Words..." National Essay Contest

The ATTC Network Coordinating Office, in partnership with Faces & Voices of Recovery, Harm Reduction Coalition, Hepatitis C Association and Help4Hep invite you to share YOUR STORY OF RECOVERY from a substance use and/or mental health disorder while coping with Hepatitis C.


Road to Recovery: Peer Support - Experience Helps Others

National Recovery MonthLike Us on FacebookFollow Us on TwitterSubscribe to Us on YouTube

Join the Voices for Recovery Together on Pathways to Wellness
Peer recovery support in behavioral health is a powerful and essential component of the recovery process. Recently, however, recognizing the importance of peer support has led to more structured and intentional applications of this recovery support approach. For example, many peer "recovery support specialists" and "recovery coaches" have received training on the most effective ways to help peers in recovery.


PCN-PAC "Private Clinic North Patient Advisory Committee" MEETING

"Private Clinic North Patient Advisory Committee"
will hold its
Recovery Month Group/Meeting
Monday, September 13, 2013
in the
PCN Group/Meeting Room

*PCN-PAC is an independent, patient-owned, patient-created Advisory and Advocacy Group co-sponsored by Private Clinic North and NAMA Recovery of Tennessee.


Dr. Jana Burson Knocks It Out of the Park

Dr. Jana Burson Knocks It Out of the Park

in Recent Book

I have never made an entry on the NAMA-R TN Blog specifically to recommend a particular book or other resource, and I am certainly overdue in writing an entry & publishing an update for our readers and supporters (I promise it is forthcoming within the next 6-7 days). However, I picked up Dr. Jana Burson's book, Pain Pill Addiction: A Prescription for Hope, earlier this evening that I ordered some weeks ago but have just been too busy to sit down & have any "me time" during which to enjoy a good book, and I simply could not put it down!


Liquid Handcuffs - Poem

Liquid Handcuffs

They call it 'liquid handcuffs',
They say I'll be it's slave
They tell me it might even
Put me in an early grave


Language Matters!!

The Words We Choose Can Shape Attitudes and Perceptions About the Disease of Addiction and its Treatment with Medicine

I don't understand terminology like "clean time" when speaking clinically about a chronic relapsing metabolic disorder. (How long since a patient's last shower?) It's important that we recognize just how much language matters when we're referring to an already extremely stigmatized and misunderstood disease.


1997 National Institutes of Health (NIH) Press Release on Methadone Maintenance Treatment

This Press Release from the National Institutes of Health (NIH) was released nearly 17 years ago... Consensus Panels were created to be a sort of "science court" on the issues their independent, non-biased panel spoke. Yet 17 years later we are still fighting much of the same stigma and misinformation that this panel already effectively addressed and settled.


Patients of Private Clinic North in Rossville, GA take notice!

The 2nd meeting of the NAMA Recovery of Tennessee and Private Clinic North jointly-sponsored Patient Advisory Committee to be held on Monday July 22nd at 11:00am!

Private Clinic North
All patients of Private Clinic North in Rossville, Georgia (metro-Chattanooga, Tennessee) are invited to the 2nd meeting of the Private Clinic North Patient Advisory Committee (“PCN-PAC”) on Monday July 22, 2013 at 11:00am in the Private Clinic North Group Room.  This meeting will be focused on a theme of “Methadone 101” including the basics of methadone therapy and a discussion of foundational aspects of MMT necessary for effective advising and advocacy in both the clinic and public arenas.
The PCN-PAC is a patient-owned and patient-operated advisory and advocacy group jointly sponsored by the Tennessee chapter of the National Alliance for Medication Assisted (NAMA) Recovery and Private Clinic North that is still evolving and taking on its shape and role in the life of the PCN treatment program.  Come and be a part of this exciting time for PCN patients in the formative stages of the PCN-PAC! Let your voice be heard.
“The goal of medication-assisted treatment is medication-assisted RECOVERY!”


Exaggerating the Risk of Drugs Harms Us All

"Doing drugs can be plenty harmful. The same goes for other activities, from big wave surfing to heli-skiing. But our tendency to overestimate the risks of drugs hampers our ability to tackle addiction."

Check out this provocative piece by TheFix.com's Maia Szalavitz...

Click here:

Exaggerating the Risk of Drugs Harms Us All | The Fix


Support. Don’t Punish.

“SUPPORT DON’T PUNISH: Someone’s mother, someone’s brother…”
“Support. Don’t Punish.” There’s probably no greater or more appropriate mantra for harm reduction proponents across the globe to espouse as their own.
This video does a tremendous job of showing the human angle of harm reduction efforts and medication-assisted treatment.  With all the issues we face and areas in which improvements are needed here in the United States, sometimes it is important to step back and recognize just how thankful we should be for what we do have.  This video features a patient from an area of Eastern Europe where methadone therapy for opioid addiction is mostly unavailable.  Political leaders of the world’s nations too often forget the factual angle that is most important when they block access to harm reduction initiatives and/or addiction medicines: Exposure to diseases, attack on the street, overdose, and so forth are all reduced substantially for most patients on methadone.  They have a better chance to stay alive.  Critics of methadone, in their pursuit of the wickedness of being "on" something, some seem too often to forget this human angle.  The death rate, arrest rate, illness rate of the opioid addicted patient drops substantially when they enroll in methadone treatment.  Their legitimate employment rate, the taxes they pay, and their immune system functioning, all rise.
The video also features a patient from Vietnam who attests to the miracles of methadone maintenance treatment.  The human angle of which I continue to speak is evident in this Vietnamese man’s testimony.  His life and his normalcy have been restored.  He is once again a productive, contributing member of society.
And while we do largely have access to methadone maintenance treatment and other harm reduction initiatives and projects in the United States, there are still people suffering from the disease of opioid addiction right here in Tennessee who can not access treatment.  Many Tennessee residents have no better access to this evidence-based and proven effective treatment than patients in countries that have largely banned methadone for maintenance treatment like Russia and Japan.  We have more than 40 years of research and data proving the effectiveness of medication-assisted treatment for opioid addiction yet the State of Tennessee Health Services and Development Agency just denied a Certificate of Need for a proposed medication-assisted opioid treatment program in Johnson City, Tennessee and the Tri Cities area.  The chairman of the committee seems to think that people can still receive treatment “if they want it,” acknowledging the 100+ miles round-trip trip to the nearest opioid treatment program, because “they can drive.”
What about those patients who, due to a disability or other condition, are unable to drive?  What about patients whose socio-economic situation is such that they do not have the resources for the gas such a drive, on a daily basis for the first several months of treatment, would require?  Or those patients who do not have access to a reliable, dependable vehicle that could make such a trip on a daily basis?  Even more of a moral outrage is the thought of opioid addicted pregnant women, knowing that methadone treatment is the standard of care for pregnant patients, having to make such a trip on a daily basis in the last months and weeks of gestation when many pregnant women should stay as close as possible to their healthcare provider(s) in the event of labor or emergency complications.  The six people who voted “no” to this Certificate of Need seem to have forgotten, or at the very least ignored, the human angle, as they have shown that personal biases and politics trump the influence of science and medical facts in their decision making.  The State of Tennessee Health Services & Development Agency has made it abundantly clear that they could care less about the opioid addiction and overdose epidemic and related deaths as they have effectively blocked the opening of a treatment center that would provider the most evidence-based and effective treatment and solution for this crisis that is currently available.
Why is the State of Tennessee “punishing” its residents in the upper eastern part of the state instead of doing all they can to “support” these people? I wish I had the answer.

“Support. Don’t Punish.” is a global advocacy campaign and you can visit their website by clicking HERE.


Help Influence Federal Guidelines for Opioid Treatment

This is your chance to have YOUR say and give YOUR input on the federal guidelines for opioid treatment programs and accreditation organizations!

See the announcement from SAMHSA below:

Help Influence Federal Guidelines for Opioid Treatment

You can now comment on the Federal Guidelines for Opioid Treatment. This preliminary set of guidelines provides detailed information to opioid treatment programs (OTPs) and accreditation organizations about what they need to comply with new requirements under the Code of Federal Regulations (42 CFR Part 8).

View the Opioid Treatment Guidelines [PDF - 982 KB]

As part of efforts to finalize the guidelines, representatives from OTPs, accreditation organizations, patient groups, the medical community, and interested members of the public are asked to review and comment on these preliminary guidelines.

All comments submitted by the deadline, July 16, 2013, will be carefully considered.

Email Your Comments [dpt@samhsa.hhs.gov]

Mailing Your Comments

Please allow sufficient time for mailed comments to be received before the close of the comment period. Written comments should be mailed to the following address only:

Substance Abuse and Mental Health Services Administration
Attention: DPT Federal Register Representative
Division of Pharmacologic Therapies
1 Choke Cherry Road, Room 7-1044
Rockville, MD 20857





The Certificate of Need for the proposed opioid treatment program by Tri Cities Holding LLC in Johnson City, Tennessee has been denied by the State of Tennessee Health Services and Development Agency.

An official statement on behalf of NAMA Recovery of Tennessee will be forthcoming and published here first over the next few days.  The State of Tennessee, through their Certificate of Need process, has violated federal law under the Americans with Disabilities Act by denying disabled Americans with chronic health conditions access to the most evidence-based and effective treatment for their illness.  It's a sad day.  The State of Tennessee has put personal biases and politics ahead of science and 40+ years of research while showing they are not serious about confronting the opioid addiction and overdose epidemic plaguing our state and the country.


Opioid Addiction the MOST lethal addictive disorder

Have you ever wondered which substance, drug or addictive disorder is the most deadly of all?  Unfortunately, the answer is in: Opioid addicts have a higher risk of death compared to other drugs and alcohol according to a new research study by the Centre for Addiction and Mental Health (CAMH) that was published in the Drug and Alcohol Dependence journal.


REMINDER: Private Clinic North - Rossville, Georgia - Patient Advisory Committee meeting TOMORROW

A reminder to all patients of Private Clinic North in Rossville, Georgia/metro-Chattanooga, Tennessee that the PCN PATIENT ADVISORY COMMITTEE kick-off Group is tomorrow morning, Monday June 17th at 11:00am in the Private Clinic North Group Room.  Be there!


ATTENTION Patients of PRIVATE CLINIC NORTH in Rossville, Georgia

Patient Advisory Committee/Advocacy interest meeting/group to be held on Monday June 17th at 11:00am

This is an official announcement from the TN chapter of the National Alliance for Medication Assisted Recovery (which also serves as the de facto chapter of the Northwestern Georgia area as part of the metro-Chattanooga, TN area) that the formation of a Patient Advisory Committee has been negotiated between the Administrator of Private Clinic North and the Director of NAMA Recovery of Tennessee.

We encourage ALL patients of Private Clinic North (PCN) living in medication-assisted recovery that are interested in advocacy and being the voice of PCN patients on matters important to them to join us this coming Monday June 17th at 11:00pm in the Private Clinic North Group Room.

NAMA Recovery of Tennessee and the National Alliance for Medication Assisted Recovery commend the owner and operators of Private Clinic North for their commitment to advocacy and doing all they can to empower their patients to have the tools necessary for medication-assisted treatment to transform their lives to living in medication-assisted recovery.  The commitment of this OTP to advocacy and the expansion of MAT while dispelling the stigma and misinformation that all too often surrounds this, the most effective modality for the treatment of opioid dependence currently available, is evident by this statement in their patient handbook: "Private Clinic North is dedicated to the removal of stigma from methadone treatment. Our commitment is to provide you with a facility that anyone would be proud to enter for healthcare (p. 27)."  This commitment of the staff of PCN is evidenced even further by their desire to provide their patients with a strong voice and avenue for education on matters of advocacy both at the clinic, state and national levels with their blessing on the formation of a patient-run, patient-owned and patient-operated Advisory Committee and advocacy group. 

If you are a PCN patient we hope to see you on Monday the 17th at 11am! If you know any PCN patients make sure they are aware of this exciting meeting! Flyers have been posted in the lobby at PCN about this. If you are not a PCN patient and would like to see a Patient Advisory Committee formed at your treatment center shoot us an email at tndirector@methadone.org if you are in Middle or Eastern Tennessee (or Northwestern Georgia) or at pgogel.TN@methadone.org if you are in Western Tennessee, and mention it to your counselor and/or program director!

"Together we can make a difference!"



Be active; Live healthy!

An important part of recovery is getting back into a routine & whatever normal is to you. I also think it's equally important for MMT patients living in recovery to focus on living a more healthy lifestyle over all - We all certainly did plenty of damage and likely some irreprable harm to our bodies & souls during years of active addiction.  Some patients with which my path has crossed that are the stongest in their sobriety as they journey the road to recovery are also some of the patients who focus more wholy on their physical and mental health overall.

Being active (even just taking a stroll or going to water exercise at the pool) goes a LONG way in combatting some of the side effects from a long term daily maintenance dose of methadone - more than nearly any other super food, supplement or multivitamin regardless of their miraculous claims. We have to own our recovery, and for me that has also meant owning my physical and mental health.

Get out and enjoy life. Have some fun in the sun. Sometimes it can make me realize just how much I have overcome since my treatment intake all those many moons ago just to be able to wear short sleeves in the summer and not having to worry about visible track marks! We have earned our recovery, our normalcy... so get out & enjoy life in recovery this summer! We deserve it.




Just a friendly reminder....

There is a Public Hearing at the Jones Meeting Center in the Johnson City Public Library this evening, May 28th, at 5:00pm.

This is quite the day on the road for me, as I am currently about to pull out of Private Clinic North in Rossville, GA of the metro-Chattanooga area. I'm headed to the Knoxville area for a couple hours then on up to the hearing in JC before 5pm.




NA and MAT... Friends, enemies or case-specific?

Are 12-step groups like NA and MAT modalities exclusive of each other?

A physician who practices in MAT modalities recently made a blog entry about 12-step groups on which there was much passionate debate in the comments where a strong majority of MAT patients and advocates made the case that any mutual exclusivity between NA and MAT has been created by the rejection, scorn and judgement that many NA groups have shown towards patients whose recovery has been successful in large part because of their being patients in MAT programs. This physician seemed to defend the 12-step groups and try to say that the MAT patients were being critical and even compared many of us to the very folks who say that methadone doesn't work and is poison - without any evidence to support their argument. 

It is hard for me to comprehend that a physician who treats MAT patients on a daily basis in both OTP and OBOT settings could be so "caught off guard" by the passionate opposition to MAT patients' involvement in 12-step groups that many patients and advocates expressed.  I have personally known multiple patients, from all across the country (and the world), who have experienced similar rejection and accusations of "not being clean" due to their employing the use of maintenance medications in their recovery... And those stories, from wide and far, were again described in many of the comments on this blog.  Let me say that I am for ALL treatment modalities, approaches, groups and anything else that offers help and hope, and I believe that ANYTHING that helps people on the road to recovery should be supported to the greatest extent possible.  I personally attended several different NA groups in the hopes of offering and receiving support on the road to recovery before the rejection based solely on the fact that I am a methadone maintenance patient took its toll and led me to conclude that these particular meetings had the potential to do more harm to my recovery than they did the potential to help and aid me in strength along my journey.  A proponent of 12-step groups recently wrote a stigma-filled editorial in my local paper criticizing methadone and buprenorphine therapies as "trading one set of chains for another" to which I felt compelled to respond with my own letter to the editor.  This editorialist only further gives credence to my conclusions that any mutual exclusivity that exists between NA and MAT has been created by proponents of the 12-step groups themselves - not by MAT patients who have sought out support at these groups with open minds as they searched for tools to aid their recovery journey.  

In reflecting on this issue further I decided the best thing to do was to go to NA World Services themselves with an open mind to find out what THEY say "officially" about the use of maintenance medications in treatment modalities.  I went to the website of NA World Services and found this bulletin (#29) that was drafted by the Narcotics Anonymous World Services Board of Trustees titled Regarding Methadone and other Drug Replacement Programs which says, in part:

"Members on drug replacement programs such as methadone are encouraged to attend NA meetings. But, this raises the question: "Does NA have the right to limit members participation in meetings?" We believe so. While some groups choose to allow such members to share, it is also a common practice for NA groups to encourage these members (or any other addict who is still using), to participate only by listening and by talking with members after the meeting or during the break. This is not meant to alienate or embarrass; this is meant only to preserve an atmosphere of recovery in our meetings."

This makes it clear that those at the "top" of the NA organization believe that those in medication-assisted treatment programs ("replacement therapy") are "still using," that they do not want MAT patients to share at group meetings, and also suggests that if MAT patients do share they would damage the "atmosphere of recovery" at the meetings. Could it be anymore clear?

What do YOU think? As for me, I rest my case.



Understanding Medication-assisted treatment with methadone and buprenorphine

Understanding Medication-Assisted Treatment

HBO's documentary "Addiction" has several supplemental series' which go in more depth on certain areas of recovery and addiction treatment than the main documentary had time to air. One of these supplementals is titled "Understanding Replacement Therapy," and while I take some issue with the title of the supplemental (the term "replacement" can lead to the misinformation and stigma that methadone and/or buprenorphine are "trading one drug or addiction for another" or are "replacing one addiction with another"), the information contained within is EXCELLENT.  This short supplemental by HBO is in two parts, each of which are less than 10 minutes long. (The total length of BOTH parts is under 20 minutes.) 

I encourage EVERYONE who is serious about having a better understanding of medication-assisted treatment for opioid addiction to watch these short films, whether you are a patient, provider, advocate, ally, friend, family member or inquiring citizen.  This is great information in an easy-to-understand presentation.

A+++.... Way to go, HBO!!

Part I

Part II


"CATTLE CALL:" All MMT/MAT patients, providers, advocates & allies to Johnson City!!


A public hearing will be held by the Tennessee State Health Services and Development Agency on Tuesday May 28, 2013 at 5:00pm.

Details are as follows:
Jones Meeting Center
Johnson City Public Library
100 W. Millard Street
Johnson City, Tennessee 37604


May 28, 2013


This is an opportunity for supporters of quality evidence-based, medication-assisted treatment for opioid addiction to show our support for the clinic proposed by Tri-Cities Holding, LLC in Johnson City, Tennessee.  Statements from those opposed to the opening of this clinic may be addressed, and we will also (hopefully) be able to answer any questions, based in truth and facts, those concerned about the proposed treatment center may have due to misinformation and generalized stigma they have been exposed to or made aware of since the proposal for this treatment center/clinic has been made public.

I strongly encourage everyone to show up and show support for this proposed clinic by attending this public hearing.  It is important that supporters of quality evidence-based, medication-assisted treatments show up in large numbers for public hearings like this.  Too many times public hearings like the one planned here have been dominated by opposition forces and misinformation has not been effectively combated, challenged or corrected.  We can not allow that to happen on the 28th of this month. The stakes are too high, and there are far too many opioid-addicted people living in the Tri-Cities, TN area that can not access the most effective treatment for their disability and disease.

BE THERE on May 28th at 5:00pm and SHOW YOUR SUPPORT for medication-assisted treatment!



Heroin Becoming More Popular as Opioids Become Pricier and Harder to Get

Are we facing a heroin epidemic?

Something I have LONG been preaching is that if Tennessee officials continue to ignore the science behind evidence-based treatments (like methadone and buprenorphine therapies) and don't work on expanding access to treatment we will soon have an unregulatable heroin epidemic on our hands.  I have seen first hand the skyrocketing costs of prescription analgesics on the streets lead to more and more opioid addicted people trying and/or seeking out heroin.  There was an article in USA Today that addressed the EXACT things I've long been warning..... Heroin is back. Is your neighborhood next? 

There was recently an article in the Maryville, Tennessee Daily Times talking about the prescription drug scourge being "out of control" and community leaders being left with the question: What CAN we do? Blount County, Tennessee (like far too many other counties in the state) has NO medication-assisted treatment (MAT) center/clinic for opioid addiction.  MAT for opioid addiction is one of the MOST evidence-based treatments in ALL of medicine. But what has happened in Tennessee is that the state, in laudable attempts to crack down on "pill mills" and other unethical medical practices, has categorized methadone clinics in with pain clinics and has "cracked down" on the very TREATMENT that is a solution to the opioid addiction epidemic!  When will Tennessee leaders put personal biases aside and look at the SCIENCE and FACTS concerning medication-assisted treatments? Not only is it the right thing to do, but we are getting to a point where state and community leaders can no longer afford to ignore the science around what the CDC has made clear is the MOST effective modality for the treatment of opioid addiction currently available!

Unlike prescriptions written by a physician and filled at a pharmacy, heroin has no way of being tracked or regulated. We are at a crossroads in Tennessee and the nation: Will we look at science and 40+ years of research and evidence that clearly shows us what works to effectively curb this epidemic before it gets worse, OR will we continue to stick our heads in the sand, ignore science, and allow a heroin epidemic the likes of which would make NYC in the 1970's and 80's look like child's play? My sincere hope is that we can bridge the communication (and understanding) gap between MAT patients, providers and advocates in Tennessee and those in positions of authority, whether elected or law enforcement, so that we can come together and deal with this crisis before it gets worse!

NAMA-Recovery of Tennessee, backed by the knowledge and resources of the National Alliance for Medication Assisted Recovery (the largest MAT advocacy organization in the world), extends our hand to work with all those who are serious about dealing with this soon-to-be heroin epidemic head on through the expansion of evidence-based treatments in the State of Tennessee.  What choice will our leaders make?  How much do they TRULY care about dealing with this threat in an effective way?  I suppose time will tell.....



CORRECTION: Johnson City, Tennessee Clinic

CORRECTION: MMT Clinic in Johnson City, Tennessee's Certificate of Need *ACCEPTED,* not approved

The Certificate of Need for the proposed clinic in Johnson City, Tennessee has NOT yet been approved by the State of Tennessee as previously reported on this blog & several other sources. I sincerely apologize for the confusion. The confusion resulted from parties (including NAMA-R of TN) getting overly excited when reading that the Certificate of Need has been ACCEPTED (the application process is complete and has been accepted by the state). NAMA-Recovery of Tennessee sincerely apologizes for any confusion & for the misinformation!!

We hope to report on the APPROVAL of the Certificate of Need VERY soon!!

In the meantime, if you haven't already, PLEASE write a letter of SUPPORT:

Health Services and Development Agency
The Frost Building  3rd Floor
161 Rosa L. Parks Blvd.
Nashville, TN 37243

ALSO, be sure to sign (and then share with your friends and family, on Facebook, Twitter and other social media) the Petition in support of the MMT clinic in Johnson City, TN as well....

"Together we can make a difference!"



UPDATE: Johnson City, Tennessee Clinic


I *just* got news that the Certificate of Need has been APPROVED by the State of Tennessee for the Methadone Maintenance Treatment Clinic in Johnson City, Tennessee!!

The fight is NOT over, though, because we will still undoubtedly have to deal with the "NIMBYism" from certain sectors of the Johnson City community. Our advocacy efforts are even MORE important now, as we must embark on an educational campaign to make sure that the community has the *truth* and *facts* about medication assisted treatments. I encourage EVERYONE who hasn't to sign the petition of support for this clinic. It will be delivered to State, County & Johnson City officials upon its completion. Here's the link:   Citizens in Support of a Methadone Treatment Clinic in Johnson City, Tennessee.

Furthermore, Steve Kester, the co-owner and manager of the company who applied to open the clinic in Johnson City, was invited to write an editorial in the Johnson City Press. He has done an *excellent* job of setting the record straight and correcting the misinformation that has too often been reported thus far. You can read the editorial (and leave comments of support) by following this link: The case for a clinic.

And, also, for those who haven't it is still extremely important to write to the state of Tennessee in support of medication-assisted treatments... Here is the address to which you can send your letters:

Health Services and Development Agency
The Frost Building, 3rd Floor
161 Rosa L. Parks Blvd
Nashville, Tennessee 37243

Furthermore, I am glad that Mr. Kester reminded the leaders and citizens of the Johnson City, Tennessee community that if they somehow block the opening of this treatment center/clinic they will break the law by denying disabled Americans access to treatment for their chronic disease (the Americans with Disabilities Act, "ADA"). If the Johnson City community unwisely choses to block the opening of this treatment center they will be sued in federal court and they will lose. There are countless federal ADA cases that have already set a clear precedent.

Again, today is a VICTORY for treatment and hope, but we can NOT stop our advocacy and educational efforts now. The opposition is sure to get even stronger, and we must continue to be warriors for the truth.



Counselor stress can affect a patient's commitment to recovery

Staff Stress Affects Patients' Engagement in Therapy

I don't know of anyone informed in substance abuse and drug treatment that would challenge the fact that the career of a substance abuse/treatment professional or counselor is stressful, difficult and challenging work. The problems that substance abuse counselors face with their patients on a daily basis are often difficult and multifarious; What's worse are the limited number of supplies and revenue with which professionals in the substance abuse field have to work (especially the majority of those employed in treatment centers that espouse a medication assisted modality of treatment). The National Institute on Drug Abuse (NIDA) recently co-sponsored a study which found that outpatient programs "can help substance abuse treatment professionals reduce their stress and more effectively engage patients in treatment."

Three physicians from Texas Christian University in Fort Worth, Texas, recently surveyed a variety of treatment professionals and patients from 89 outpatient programs spanning 9 different states and found...

  1. When staff members reported lower levels of stress, patients reported more active participation in treatment.
  2. Treatment programs may reduce staff stress by giving employees a voice in organizational policies and procedures.
  3. Staff with a higher level of influence in the organization within which they work displayed a better tolerance of stress and burnout than staff with lower levels of influence.
  4. **Staff stress and burnout was less prevalent in programs with higher patient caseloads than those with lower patient caseloads.**

For patients I feel that the 1st and 4th finding (as displayed in the list I put together here) are of particular interest and importance. It's interesting to note that patients who are treated by counselors with lower levels of stress tend to report a more active participation in their treatment. This shows that there is a direct correlation between a counselor's mood/attitude/visible stress and the effectiveness their therapy may have on a patient. It's always been very visible and clear to me if ANY of the staff at an opioid treatment program is in a bad mood, or seems "stressed out," and, while reflecting back while writing this blog entry, it has always had an impact on my approach while at the program on that particular day. For example, if a staff member or counselor seems upset or otherwise "stressed out," I am less likely to ask to speak to a counselor or otherwise ask or make a "non-routine" question or request regardless of how important the issue I am neglecting as a result of perceived staff stress may be to my treatment and recovery. This perception of staff stress, as the study from Texas Christian University now official documents, directly affects and impacts the level in which I participate in my treatment when reporting to the program on a scheduled treatment day. 

It also is very interesting that there are lower reports of staff stress and burnout in the treatment field for counselors who have higher patient caseloads than their counterparts with lower caseloads. This initially seemed to go against what I would have originally assumed. However, "researchers speculate that counselors who have more patients to treat can channel their stress positively into a sense of challenge that may be protective against burnout." So instead of higher caseloads, by their very nature, resulting in more stress for treatment professionals it appears that the higher caseloads may actually serve as a therapeutic channel through which counselors themselves are able to receive a type of quasi-therapy. 

Overall, though, the findings of this NIDA-supported study conducted by Texas Christian University are extremely relevant, and important, to both the staff and patients of treatment centers/clinics alike. Patients will serve themselves well to realize that the perceived stress or mood of their treatment providers can affect their approach to, or involvement in, treatment at any given time. Recognizing this trend could allow patients to acknowledge the influence stress in their OTP's staff could have on their treatment and, as a result, consciously make efforts to fully engage in their treatment notwithstanding any hesitation such perceptions might have initially caused. Treatment center/clinic staff and counselors can now fully recognize the therapeutic value for oneself work in this challenging field can procure and, as a result, come to a new understanding of and appreciation for their calling.


Landrum, B.; Knight, D.K.; and Flynn, P.M. The impact of organizational stress and burnout on client engagement. Journal of Substance Abuse Treatment 42(2): 222-230, 2012. (Abstract)


No More NIMBY ("Not In My Back Yard")

No More NIMBY (Edited Version)

NIMBY is a common acronym that stands for "Not In My Back Yard."  This is, unfortunately, an acronym that the MAT/MMT community typically always has to deal with when a new treatment center/clinic is proposed to open in an area where one has not previously existed. Due to some communities where new treatment centers/clinics are proposed to open not having had a medication assisted treatment program present in their area before, MAT/MMT advocates often run up against community opposition, "NIMBYism," that is based in misinformation, misunderstanding, lack of understanding and a general lack of awareness concerning the facts and truth in medical and scientific research surrounding the chronic disease of opioid addiction and the most effective modality for its treatment, medication assisted therapy.  

This amatuer video by an opioid addicted patient who was able to regain and live a meaningful life in sobriety on the road to recovery thanks to the modality of methadone maintenance treatment does an excellent job of explaining what NIMBY is, how it has been employed throughout history on a variety of issues and how preventing treatment centers/clinics from opening in a community based on NIMBY and without legitimate reason or cause is a violation of the federal Americans with Disabilities Act (among other things).

This short video does a good job of dispelling some of the myths and lies fueling the unfortunate NIMBY trend when it comes to methadone maintenance/medication assisted treatment centers/clinics. The arguments against medication assisted treatment programs are senseless, and NIMBY is a direct contributing factor in many areas for the lack of available treatment programs, long waiting lists, fear of discrimination and, ultimately, overdose deaths due to untreated opioid addiction. 

Take a few minutes to watch this video, and the share it with your friends, family and acquaintances. You will be thankful you did, as this is especially relevant considering the opposition the treatment community is facing to the proposed clinic in Johnson City.



Opposition to Proposed MMT Clinic in Johnson City, Tennessee Grows

Johnson City methadone clinic opposition grows

ALERT, ADVOCATES!! We need to, and must, promote the *truth* and do *all* we can to help raise awareness in light of the proposed Methadone Maintenance/Medication Assisted Treatment center/clinic in Johnson City, Tennessee. The new clinic is being met with much opposition, and, as usual, the opposition is based on misinformation and stigma... 

I also find it "curious" that the Vice President of Frontier Health, an abstinence-based "detoxification" treatment program, is one of the leading voices of opposition against the proposed treatment center/clinic cited in this article saying that abstinence-based treatment gives the opioid addicted the "best chance of a better life." REALLY? It's interesting he didn't cite any medical or scientific sources supporting his statement... Probably because there are none

The article can be read via the hyperlink within the heading of this blog entry... Read it, and be informed. I have reached out to the NAMA-Recovery Board of Directors as well as the Chapter Directors of other states and areas for input and assistance... Details will follow over the next few weeks and months as this develops further and to inform everyone of any public meetings, hearings or forums that might be held or scheduled on this matter. This blog will also keep you informed of any organized, official efforts on the part of NAMA Recovery of Tennessee.

Letters of support can be sent to:

Health Services and Development Agency
The Frost Building, 3rd Floor
161 Rosa L. Parks Blvd.
Nashville, TN 37243


Positive Effects of Methadone Clinics



Methadone Clinics (or Opioid Treatment Programs, "OTP's") provide a safe way for people suffering from the chronic disease of opioid addiction to receive the most effective known treatment for their illness. Learn a little bit about how Methadone Clinics teach patients suffering from opioid addiction to re-learn and re-gain productive behavior with help from a licensed mental health counselor or other professional in this free video on methadone treatment and drug addiction.

While I firmly believe that this licensed mental health counselor (LPC) has a view of methadone maintenance treatment and the clinics that provide this life-saving, life-restoring treatment that is rooted in evidence-based research and scientific/medical facts and data, I regret that some of his "word choices" could potentially perpetuate stigma (He speaks of one's "drug maintenance" being supervised by medical professionals, and referring to the *medication* methadone and the maintenance therapy that employs its use as one aspect of the treatment modality as "drug maintenance" could lead to a mythological impression or assumption on the part of the viewer that methadone maintenance treatment simply switches out one "drug" for another legal "drug.") Also, for example, the use of the word "swap" when describing or referring to ANY aspect of the methadone maintenance treatment modality (he mentions MMT "teaching addicts to swap addictive behavior for more productive behavior"), due to the potential confusion that also contribute to the common stigmatizing misinformation, like mentioned before, that methadone treatment/therapy "swaps" one addiction for another "addiction." (I must make an important note here that there is a significant, real & important medical difference between "addiction" and "dependency" for which I will address in a separate entry on this blog in the future.) 

Overall, however, the main notion that "methadone clinics are a good thing" is very true and much appreciated.

Former MMT Clinic Medical Director Pleads Guilty

Records: Former clinic director to plead guilty in prescription abuse case

As unfortunate as this entire situation is, I feel it is something that needs to be addressed by our chapter since this is something that occurred here in Tennessee at the clinic where I originally started my journey on the road to recovery in medication assisted treatment years ago. This was actually the doctor that did my original intake when I first became a patient at BHG Knoxville Medical Clinic Central on Citico Street. (Note: I am no longer a patient of BHG, and I haven't been for some time.) It's a sad fact indeed that this physician was treating patients struggling with the chronic disease of opioid addiction, and seeing the benefits of methadone therapy first hand, while she was evidently struggling with the same illness herself behind closed doors. May I say that I wish her the best in HER own recovery, and I certainly hope that she can find some peace after this storm of criticism and legal problems.

That being said, I want to take a minute to talk about the responsibility our treatment providers and those who work in addiction medicine have and owe to the community and their patients. Even more problematic for our community than criticism of a former MMT clinic director being involved in an illegal prescription drug scandal and admitting to her own addiction to opioid analgesic medications is the overall dark cloud this unfortunately leaves behind for all of us who remain responsible, law abiding and mentally sound members of the MAT/MMT community to deal with. This only furthers the stigma we are trying so hard to eliminate... which leads me to this: Those who own, operate or otherwise work at medication assisted treatment centers and/or clinics are held to an even higher standard of moral judgement and must be even more aware of how their decisions and actions can impact the entire MMT community, patients and providers alike. I long for the day when all treatment centers and clinics take this commitment to ending the stigmatization of medication assisted treatment as Private Clinic North in Rossville, Georgia does; who in their "patient handbook" clearly states: "Private Clinic North is dedicated to removing the stigma of methadone treatment. Our commitment is to provide you with a facility that anyone would be proud to enter for healthcare."

How effective can patients and advocates truly be in eliminating stigma and countering myths and misinformation if the very folks who operate and/or oversee the clinics are doing or are involved in things that give our opponents fuel for their fire? This is something that I hope all treatment center/clinic owners, operators and employees think about very seriously...



Road to Recovery Update: Have Your Questions Answered by the April Expert

Road to Recovery Update: Have Your Questions Answered by Our April Expert

Be sure and read the April "Road to Recovery Update" by SAMHSA (Substance Abuse and Mental Health Services Administration). If you have any questions related to information in the April edition, you can ask them & they will be answered by SAMHSA's "April Expert." Also, be SURE to watch the April "Road to Recovery Program" on building public awareness and community support! :-)


Recovery is Worth It!

Recovery is worth it! Not convinced? Here are 100 reasons! :-)

(Thanks to SAMHSA's Recovery Month for producing this video.)


NAMA-R President's Blog: Ira Marion 1945-2013

President's Blog: Ira Marion 1945-2013

Use the link above to read an entry by Joycelyn Sue Woods, MA, CMA, Executive Director of the National Alliance for Medication Assisted Recovery, on the NAMA Recovery President's Blog about the passing of Ira Marion.

~Rest in Peace~

NIH Study sheds light on how to reset the addicted brain


The implications of the research continuing to be conducted by the National Institutes of Health (NIH) and other medical & research organizations is amazingly huge... We are gaining a better and better understanding of how addiction affects certain areas of the brain. Even though this study was based on cocaine addiction, it confirmed what we already largely knew: deficits in the prefrontal cortex are involved in drug addiction. This information gives us a better understanding of these deficits and shows even more promise for developing effective therapies that target that part of the brain... This could translate into a better understanding of (and, as such, better treatment modalities to treat) opioid addiction as well. The field of addiction treatment and medicine is alive and well as evidenced by the massive strides in research and understanding that are developing each and every day.




It couldn't be more clear: We must continue to work and advocate for methadone maintenance treatment being available in EVERY community ON DEMAND for patients suffering from opioid addiction when they want/desire to begin treatment.

The National Institutes of Health (NIH) just released a study in conjunction with the U.S. National Library of Medicine that shows the longer the patients have to wait to begin methadone maintenance treatment the higher the risk of death until they are able to begin treatment. These statistics should move ALL people with a moral conscience to do everything possible to expand treatment, accessibility and affordability in every community in every country across the globe. How much more TRUTH in medical/scientific research and facts must be known before the stigmatization and misinformation plaguing the life-saving and life-restoring modality of methadone maintenance treatment will cease?



Cincinatti program offers addicted moms help, hope

This article shows the HOPE that MMT can offer opioid-addicted women when they become pregnant and how MMT is completely safe for the embryo/fetus and doesn’t harm the baby in any way… But, at the same time, I’m not really pleased with the way this article is worded in many places because I fear that it could be twisted & used against MMT by those who have that agenda despite it outlining a MMT program for pregnant women that provides HOPE… The BIGGEST issue I have with this article is this line: “Some babies show relatively few symptoms and don’t need treatment related to methadone, but others exhibit signs of addiction.” (NO, they DON’T… they exhibit signs of DEPENDENCE… NO baby is “born addicted.” There’s a BIG difference…) So, like I said, this article tells us about an AWESOME program that is a testiment to the safety and effectiveness of MMT for pregnant women, but, at the same time, isn’t worded in the best way in MANY places (including the very first sentence)… So my overall reaction is mixed.


What We Say Matters

What We Say Matters

Let me talk about language for a second.  In our society, the way we phrase things has a major effect on the perception of what we say.  That's why, when talking about something as controversial as methadone treatment, it's important to use language that is beneficial to our cause.  Terms such as "medication assisted treatment" help communicate the idea that methadone maintenance is a legitimate therapy that is medically necessary.

Language is most important when it comes to how we describe our treatment.  Methadone opponents, the news media, and sometimes even patients themselves often fall in to the trap of referring to methadone as "meth".  While calling it "meth" may seem like simple shorthand, the word also refers to an illegal drug with major negative perceptions.  So much of language's effect is subtle and unconscious.  When a newspaper refers to a new "meth" clinic opening, it misrepresents a treatment that is already disliked by many.

Using the correct language is only of the necessary steps we must all take to legitimize methadone treatment in people's minds.  Every time a patient is caught selling drugs at a clinic, every time a methadone patient gets in to an auto accident, every time someone sees methadone patients milling around the clinic in their pajamas, smoking cigarettes -- all these things add to the public's negative perception of methadone.

Using the right language when describing our treatment is one easy thing we can do to make it more acceptable in people's minds.

Suboxone May Not be as Safe as Previously Thought

Suboxone (buprenorphine/naloxone) May Not Be as Safe as Previously Thought

One way I get material for this blog, and something I hope to use more in the future, is to go through the Pubmed website and read studies.  While looking through it today, I happened upon an interesting study dealing with buprenorphine/Suboxone.

Suboxone is often held out to be safer than methadone.  Methadone is known to stop breathing when taken in high doses or when taken in moderate doses and mixed with benzodiazepines.  Suboxone, due to its status as an opiate agonist/antagonist and its "ceiling effect", is presumed to be much less deadly than methadone.  The conventional wisdom is that it is nearly impossible to overdose on Suboxone alone.  This may very well be so.  However, a new study I happened upon showed that, at least when mixed with benzos, Suboxone is not without risk.

This study examined autopsy results where buprenorphine was present in the blood of the deceased.  The autopsies showed alprazolam (Xanax) present in a full 40% of the dead, and it found some other benzo or sedative in 75% of the cases.  Perhaps even more surprising, buprenorphine was the only drug found in 10% of the cases.

We can conclude two things from this study: like methadone, mixing benzos with Suboxone can kill.  Furthermore, the presence of buprenorphine alone in 10% of the samples shows that it might be easier to overdose on Suboxone than is commonly thought.

I encourage people on methadone to stay away from recreational use of benzos, especially if they're taken in high doses or mixed with alcohol.  This study shows that the same advice may go for those on Suboxone.

*EXCELLENT* Video with Comprehensive, Easy-to-understand overview and explanation of Medication-Assisted Treatment

Part 1 of 2

Part 2 of 2

HBO Knocks it out of the park!

HBO's documentary "Addiction's" Supplemental Series video "Understanding Replacement Therapy" is, by far, one of the best concise video explanations of the chronic disease of Opioid Addiction and Medication-Assisted Treatment (includes a discussion of both methadone and buprenorphine). This is a MUST WATCH video for *all* MAT/MMT patients, providers, family, friends & allies! This is a wonderful resource for those who don't fully understand Opioid Addiction as a treatable medical condition, much like diabetes, hypertension and asthma, or who may cynically view Medication-Assisted Treatment as the "trading of one addiction for another." This is a video that EVERYONE needs to watch multiple times! A+++!!