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+++!!