Opioid Addiction from Different Perspectives

Perspective is Essential









I was asked to speak as a member of a panel about opioid use disorder, at the annual addiction conference at the University of North Carolina at Charlotte (UNCC) this month, called the McLeod Institute. This conference was named after Dr. Jonnie McLeod, a great leader in the field who passed away several years ago.

I’ve spoken at this conference several times before, and it’s always a treat. It lifts my spirits to see new recruits entering the field of substance use disorder treatments, all fresh-faced and enthusiastic.

One whole day of the conference was devoted to the problem of opioid use disorders, and I’m sorry I couldn’t attend the morning’s events. After lunch, the five of us on the panel took our seats.

At one end was the operator of an abstinence based, 12-step oriented non-profit outpatient treatment program, one of the best in Charlotte. To his left was a Charlotte-Mecklenburg police officer whose focus was on interdiction of heroin flooding the streets of Charlotte. Then there was me, and to my left was Donna Hill, program director for Project Lazarus in Wilkes County. At the extreme left was Jennifer, a social worker from New Jersey with many years of experience in the substance use disorder counseling field.

We all introduced ourselves and said a little about how we approached the treatment of opioid use disorders. When it was my turn, I did my usual spiel about how treatment of opioid use disorder with medications including methadone and buprenorphine and naltrexone are the most evidence-based treatments available, yet still have the most stigma against them. I told them our country overused treatments that don’t work, sometimes over and over. I told the audience I worked for an opioid treatment program and had my own office-based practice where I prescribe buprenorphine.

The whole point of the panel was to allow the audience to hear the different viewpoints on our nation’s problem with opioid use disorders, and the panelists didn’t disappoint.

Of course the director of the 12-step oriented, abstinence-based outpatient program advocated for that form of treatment. He made some neutral-to-negative comments about MAT, but he wasn’t as vehement as I expected.

The police officer, not being involved in treatment, mainly gave facts about how awful the heroin problem is in Charlotte. He said it was one of the two hubs, along with Columbus, OH, that drug cartels were using as a base for sales to all the other towns in the Eastern U.S. He explained how the purity had risen and how fentanyl and carfentanil were now being added to heroin or being sold as heroin, because they were cheaper to make and many times more potent. He repeated the account of a police officer who had to be treated for a severe overdose that happened just from brushing heroin off his sweater. (I did read about that on the internet and had some questions regarding the story but wasn’t about to quibble with a man with a gun.)

Donna from Project Lazarus probably could have justified talking the longest, since Project Lazarus is active in so many aspects of treatment, prevention, education, and community outreach, among other things. She gave a nice summary of all the things Project Lazarus does, and encouraged people to call them if they wished to set up a similar organization in another place.

Jennifer the social worker said some good things about how all of us treating opioid use disorder need to work together and communicate, but then, in my opinion, she blew it when she said she disapproved of how treatment programs take advantage of people with opioid use disorders by charging them money to be in treatment. At first I didn’t know exactly who she was targeting but when she said clinics discouraged patients from getting off methadone and buprenorphine only because it was bad for their business, I felt my ire rising.

You know I had something to say about that.

I got a little heated, and said I didn’t think it was fair to imply opioid treatment programs were unethical because they charge patients money to be in treatment. I said other medical specialties charge money for their services, and that this was the way this country approached healthcare. I went on to say that opioid treatment programs don’t keep patients on methadone because it’s a business model; it’s because patients who leave methadone treatment at an OTP have an eight-fold increase in the risk of dying, and a high risk of relapse with all the misery that can come with it: poorer mental and physical health, fractured relationships, damaged self-esteem, lowered personal productivity.

After all, I said, is there any other medication for any other disease that reduces the risk of death by eight times, that has the stigma against it that methadone does?

OK…it’s possible I’m more lucid as I’m writing this than I was in the moment, but I blurted out something to this effect.

Other than that incident, I was relatively well-behaved.

I liked all my fellow panel members, even though we didn’t agree about everything. We all agreed on the most important thing – we all want to keep people from dying from opioid use disorder, and we all want them to find a good quality of life in their recovery.

I stayed to listen to the second panel, composed of people in recovery from opioid use disorder. There were six people on that panel, and of the six, five were either neutral or critical of methadone or buprenorphine. These five people all said that 12-step recovery in Narcotics Anonymous allowed them to quit using drugs and live a successful recovery.

The last patient was different. She gave a brief history of her recovery, and said that though she found 12-step recovery helpful, she needed methadone to return her to a place where she could function normally. She described being off opioids for some months, but being plagued with post- acute withdrawal that ultimately lead to a relapse. Now, she considers methadone a necessary medication for her, and said if she had to be on it for the rest of her life in order to feel normal, she could accept that.

I was so impressed with this lady’s courage. It had to be hard to follow five peoples’ stories that all centered on abstinence-based recovery with her story of being in a form of treatment with so much stigma against it. I was very pleased by what she was saying, and felt like she was speaking for all the people who have benefitted from medication-assisted treatment.

I was disappointed there wasn’t more diversity on this panel. I don’t doubt the other five peoples’ recovery stories, but they were very similar. One of them spoke very negatively about methadone, but later revealed she misused her methadone to an extreme degree and came off a relatively high dose “cold turkey,” which of course is not recommended. Another six people in recovery from opioid use disorder may have the opposite experience with 12-step recovery and medication-assisted treatment

I was socializing with some of the panel members before leaving, and to my surprise, the operator of the non-profit abstinence-based outpatient program told me he was sorry if it sounded like he was trying to bash methadone treatment. I was surprised and pleased, and thanked him.

I’m glad I was there, and I’m glad to see fresh recruits joining the effort to help people with opioid use disorder in their recovery.

17 responses to this post.

  1. Posted by John on May 23, 2017 at 2:51 pm

    I wish i could have been on that panel of recovering addicts, i could have told them how i lost everything in my life to opiate addiction, my wife, my job, my home, and my car (hard to make payments when every dime you have earned and or stole goes to pills) then i would have told them since i have been on suboxone (3years) i now have a successful corporate job and i am a functioning, tax paying member of society again. Its my opinion that people, especially those that have never been through hell, will never ever understand and continue to look down on us while they twist a lemon into the 4th glass of booze. Of those 4 12 step people there are thousands that have started 12 step bs that quit after the first week, THOUSANDS. Maybe this is true with suboxone treatment as well, but i guarantee the reason people quit suboxone therapy is more often than not a problem of they simply cant afford treatment period. The cost is certainly better than it was 3 years ago but i still fork over 300 cash a month to my clinic and im lucky enough to have prescription insurance so not much on meds, but when i was first starting recovery i didn’t have it and paid another 400 a month on meds. So there you have it, someone needs desperately to help the people who cant afford treatment, and i see it getting worse with this current administration before it gets better.


    • Thanks for writing with your experience.


    • Posted by addictionspodcast on July 24, 2017 at 9:30 pm

      I hear you there. I am a recovering addict as well. Opioid pain killers. Five years. Terrible. Started due to a broken femur. Took as prescribed. Became physically dependent. Tolerance grew. So did my dose. Doctor dropped me as a patient because I asked for a refill three days early.

      Started buying drugs on the street. The. I woke up. Well. Hit my bottom then woke up. I have too much to live for to throw my life away. My daughter. She is my life. I have pain. But it is nowhere near the pain I went through due to addiction

      Best of luck to you friend. We are all in this together.


  2. Posted by Kenneth Gaughran on May 23, 2017 at 4:56 pm

    I am new to your blog and I have to say I am so happy that you offer up your experiences from a physician’s stand point of the incredible blindness and proverbial
    disregard for evidence based procedures regarding the science behind harm reduction. I am a recovering cross addicted addict,counselor and free-lance writer on addiction(some of my pieces can be seen on “The Fix”),

    I haven’t had a chance to read your blogs, but I couldn’t agree with your more that most addicts just can’t walk away from the insidious re-wiring of the brain and enteric nervous system that these drugs do in hijacking the neurotransmitters and other essential coping mechanisms. As far as MAT use on Long Island-where I live- the program is failing because of not only the the dearth of psychiatrists, but of those willing to practice in the non methadone MAT arena find it economically impossible
    because of litigation and poor reimbursements from government agencies. Exacerbating this problem is the stigma and reality that addicts are not compliant and
    physician’s who are big achievers and need results become frustrated by the non-compliance world of addiction.

    Obviously that brings to light the whole disaster of government reimbursements and policies. I can understand as a former homeless addict the social workers Maslowian
    sentiment of the money aspect-after all when your are in the dark world of addiction-money is the last thing you have. And whatever non-illicit drug money you have, goes to food or cigarettes or some other life sustaining item-here is where a European Single Payer system or a pension for addicts program like Australia does with its compulsive gambling program makes sense.

    However, as long as “shame” permeates in our society(on a conscious and unconscious level)among our dreadful gov’t leaders and the status quo of America that addiction is a moral failure, this sentiment inevitably trickles down to the user and without self-love, poor self esteem ensures continued substance or addiction abuse.

    Until America realizes addicts need a “cocoon” like environment that provides: time,love and science based modalities like MAT programs and Motivational Interviewing and a stipend that allows them to actuate like human beings, than we will continue to have a paranoid schizoid approach rather than a repairative environment in treating addicts

    I know this sounds like a Pollyanna approach-but as Portugal and Sweden have proven basic human rights must be afforded these sick people before we have widespread change. The old mantra that you have to go through “B” to get to “C” is absurdly being forgotten in our ill conceived program to eliminate addiction.

    Thank goodness their are empathetic and scientifically informed people like your self
    who walk the walk instead of talking the talk. Thank you for your wisdom and compassion.

    Kenneth Gaughran


  3. Posted by Brooke Stanley on May 23, 2017 at 7:06 pm

    Dr. Burson, Thank you so very much for your kind words. They mean more to me than I can express.

    I must admit, as each person on my panel spoke, I became more anxious. Fear and doubt swept over me. I made a mental note of all the exits and, for a brief moment, considered walking out. A little voice told me that I wasn’t worthy to speak and that if I was really doing well in recovery that I would be abstinent from everything, including methadone. That was the same voice though, that prevented me from trying Medication Assisted Treatment for so long….I know that voice is my disease and it is a liar. I refuse to allow it to steal another moment of my joy. More importantly, my truth needs to be heard. There are people out there that are resisting treatment because of the stigma. People are dying. Enough is enough. If my story saves just one person then it is worth being told. I want people to know that methadone maintenance saved my life. So when it was my turn to speak, I told my story proudly, without any shame. MAT was part of my path to recovery and my life now is proof that it was a good path.

    Thanks again for all that you do to support me and so many others in recovery!!


  4. Posted by Rocky Hill on May 23, 2017 at 11:05 pm

    After all the studies and all the saved lives, I just find it amazing that, even well intentioned people, still want to stick to their roots. I am sometimes reminded of the military school, I attended, or the fraternity that I pledged. All, carried a sense of belonging from having experienced a mutually painful experience – hazing. The mind-set was based around “we went through it and you need to too”. It was, like a right of passage. As I progressed, in both, I just couldn’t see the benefit of shared unity, through a painful process. Some, didn’t make it, and that seems to be where we are with the stigma of “insufficient suffering” on the part of those who can step off the opiate with methadone or buprenorphine. I get the sense, from some that it just isn’t fair that they don’t suffer enough. My own recovery, began in 1980, with a year long withdrawal from 80mg./8 yrs. from valium. I barely made it, having decided, on numerous ocaisions that I was just going to drink once to get some sleep. Fortunately, divine intervention interceded. Why does someone who has achieved a state of enhanced functionality, a stable family and all the advantages of recovery, lack the same rights to lead an NA meeting that folks who withdrew from meth, cocaine or alcohol, or even opiates. We need to look into our hearts and really decide if more suffering, makes us more spiritual or serene. I think that it is the choices and willingness to surrender that gives me my joy today, not the 8 mgs. of buprenorphine that I take to alleviate shoulder pain and PAWS. Many of us are getting older, and our treatment facility finds that buprenorphine provides tremendous pain relief for chronic sufferers and eliminates their paws. Why would anyone resent that? Great article, as usual.


  5. Even Betty Ford/Hazelden put some of their patients into MAT programs now – they got tired of seeing them die after discharge — Not everyone can make it on abstinence and 12 steps alone — even the insurance companies are figuring out rehab/relapse/rehab/relapse isn’t cost effective.


  6. Posted by Kayce Victoria on June 24, 2017 at 3:15 pm

    I’m so glad I stumbled onto your blog! I’m doing research to start my own blog about opiate dependency. I’m a recovering addict on methadone. My main motivation was the stigma attached to methadone, and I agree that is due to lack of education. I wanted to be heard! I get worked up thinking about jails & prisons throwing someone in a hole to detox. It’s unthinkable! I greatly appreciate the work you do & I think your amazing for standing up for what you believe in as a Doctor. I feel like your fighting for me! I hope you know it doesn’t go on deaf ears & that you’ve helped at the least, one person today! So thank you!


  7. Posted by addictionspodcast on July 24, 2017 at 9:31 pm

    As a recovering addict (seven months clean and counting every day) this really strikes a chord with me.
    Through my five year long battle with opioid addiction, I learned so so so much about addiction, withdrawal, relapse, rehab, drugs themselves, strategies for staying sober… the list goes on. Anyways I decided to put my knowledge to use and so I started a weekly podcast called Addictions on iTunes and googleplay.
    I feature valuable insight for anyone effected by addiction check it out if you get a chance. My WordPress site will lead the way to your listening pleasure.


  8. Posted by addictionspodcast on August 8, 2017 at 10:54 am

    Totally wish I were there. I would have loved to share my story. You can read it on my blog.

    I actually do a weekly podcast about addiction.
    The new episode entitled “Physical Withdrawal Strategies” is now available. Be sure to check it out on your favorite podcast app or directory, or follow the link below.



  9. Dr. Burson, Do you have any data/information on regarding methadone dosage with clients are showing evidence of positive UDS”s for fentanyl? My NKY OTP clinic is seeing a 19% spike in these positives and wondering if changes in their dosage may be indicated.
    Mark Fisher, Regional Director QI, Pinnacle Treatment Services


    • No I don’t, except I’ve heard doctors talk about anecdotal information. I think we are wondering if fentanyl users will need higher doses. For sure if I were to get back a fentanyl positive, I’d ask the patient about withdrawal or cravings & I think a dose increase would be warranted.


      • Posted by bpmurraymd on August 31, 2018 at 12:13 am

        the people in Baltimore noted that there is no ‘blocking dose’ of methadone for fentanyl — unlike patients often experience for other opioids. when they are on an adequate dose of methadone, patients say they don’t get a buzz from using heroin often. They got methadone up to 400 -500mg/day and patients could still ‘get high’ on fentanyl. That is sometimes an issue with fentanyl use. Otherwise , we treat it like any other opioids. Why are they taking it ?– would more methadone treat that reason like cravings or withdrawal? . and be sure they get Narcan

      • Thanks very much for your response…

      • Posted by bpmurraymd on August 31, 2018 at 1:01 pm


        Methadone maintenance treatment among patients exposed to illicit fentanyl in Rhode Island; safety, dose, retention, and relapse at 6 Months

        this is the article from Andrew Stone in RI who has a lot of experience with Fentanyl . They allow or start MAT in their jails in RI and have had great success continuing

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