Posts Tagged ‘Narcotics Anonymous’

Year in Review: 2018 and the Treatment of Opioid Use Disorders

This year has been difficult for many people, due to disasters both natural and unnatural. As in any year, good things also happened. Since my blog concentrates on opioid use disorder and its treatment with medication, this entry will focus on the positive events in my field. I’ll save the more negative events for another blog, when I’m feeling grumpy, for those days will surely come.

This last year, the problem of opioid use disorder is got essential attention from governmental agencies, the press, and the public in general. For too long, no one was talking or caring about this issue. Now, this widespread medical problem is getting the kind of attention that leads to change: financial attention.

Big money for treatment

The CURES grant money, approved by legislation in late 2016, made almost a billion dollars available to help treat opioid use disorder. That money was released starting in early 2017, and has helped many patients.

In mid-2018, legislation was passed to approve another near-billion dollars to treat opioid use disorder and its prevention. Called the State Opioid Response, or SOR, this money will be released through SAMHSA to each state’s single-state agency. This money must be used for prevention and treatment, and to increase availability to medication-assisted treatment with the three FDA-approved medications: methadone, buprenorphine, and naltrexone.

From my reading of SAHMSA’s description of the SOR grants (https://www.samhsa.gov/grants/grant-announcements/ti-18-015 ), most of the money will need to be used for treatment with MAT.

This is big money, and is intended for treatment that includes evidence-based treatment with medications. In other words, the abstinence-only, “we don’t believe in medications” type programs probably won’t qualify for these grant dollars.

I’d like to pause and say a big “Thank you!” to the legislators who wisely crafted this grant.

As an example of fiscal irresponsibility of the past, with CURES dollars, some areas of our state cycled patients through five-to-seven- day detox admissions that had very little chance of helping. We’ve known the abysmal data from such short stays for decades, yet many treatment dollars were flushed down that detox drain.

Now, to get grant money to pay for detox, patients will need to start on naltrexone (probably the month-long depot injection) prior to leaving the facility. This makes sense and should improve patient outcomes. They could also be started on methadone or buprenorphine, but presumable inpatient detoxification wouldn’t be needed to start these medications.

The end of a detox is a perfect time to use naltrexone. Once a patient has started on it, it’s much easier to continue, either at an opioid treatment program or even in a primary care office. Since it’s not a controlled substance, physicians and extenders don’t need a DEA number to prescribe this evidence-based medication.

We’ve seen the benefit of CURES grant money at our opioid treatment program, where patients are treated with either methadone or buprenorphine. (We also offer naltrexone, but don’t often get patients when they are suitable for this medication, since they are actively using opioids.)

Before CURES, self-pay patients had difficulty remaining in treatment, and often opted to taper out of treatment before they were ready. Now, we’ve seen those people stay in treatment and thrive. I don’t have data, but I’m sure it is being collected. Now with continued money from the SOR grants, we can continue to provide care to people who have no way to pay for care.

Sometimes people get angry about public funding for MAT. They feel that since they must pay for the treatment of their own chronic disease, patients with opioid use disorder should, too. I can’t comment on the fairness aspect, but I do know that each dollar tax payers spend on MAT saves between $4 – $11 in tax expenses, most of which is saved on incarceration costs, medical costs, and the like.

Personally, I’m happy my tax dollars go towards such a great investment.

Tolerance and inclusivity at some 12-step meetings

I see a trend of tolerance and inclusivity in the recovery communities…at least in my area.

In 2018, a new Narcotics Anonymous group started here with the express purpose of welcoming people on medication-assisted treatment for opioid use disorder. Since I work with patients on medication-assisted treatment, this delighted me. Some of them want to go to 12-step meetings, either Alcoholics Anonymous or Narcotics Anonymous, but don’t feel welcome at the existing groups. Now they have a meeting where they won’t be judged for being on medication, if they chose to share that fact.

This meeting was started by a handful of long-term members of Narcotics Anonymous with more than fifty years of recovery between them. They intended to honor the traditional primary purpose of all 12-step groups: to carry the message of recovery to those people still suffering. The founders of the meeting felt tearing down barriers for people on MAT was the best way to adhere to that primary purpose. At this new meeting, such NA members are full members, with the right to speak at meetings, do service work, sponsor and be sponsored.

The meeting started in February, and attendance ranged from two people to fourteen people per meeting. It’s still in a fragile state, with only a few people coming to nearly every meeting, but it’s a good start.

Some NA members have attended who didn’t share the group’s stated position on the topic. They too were welcomed warmly and asked to return frequently. Attendees don’t have to agree with the group’s position on MAT, as long as they respect the group and its members. Again, emphasis is on inclusivity. Also, the “still suffering addict” isn’t always a newcomer. Sometimes it’s the person with the most time in recovery, so everyone needs to be welcomed.

This is my opinion: if 12-step groups don’t embrace people seeking recovery who are on medications, they will become less relevant. If they fail to reach people on MAT, they will have failed their stated primary purpose, from a lack of open-mindedness and willingness, two of the essential spiritual principles of 12-step meetings.

Breaking Down Silos

I’ve seen and participated in more cross-specialty discussions about MAT in 2018.

In the past, medication-assisted treatment took place at opioid treatment programs (OTPs) and no medical providers outside the OTPs knew what happened there. Some providers and owners of the OTP companies preferred it this way; a low profile might mean no protesters outside, shouting NIMBY (not in my backyard) slogans. They tried to keep everything hush-hush, so the community wouldn’t try to expel them.

Now, providers at OTPs and owners of OTPs are asked to participate in the recovery efforts of people with opioid use disorders. Slowly, as communities desperate for answers have turned to the scientific literature for how best to treat opioid use disorder, they’ve re-discovered the literature that’s been the foundation of MAT at OTPs for decades.

Last year, I was asked to speak to a variety of groups about what we do at opioid treatment programs. In May, I spoke to a conference of U.S. probation and parole officers. In September, I was on a panel of people who spoke at a conference for pharmacists. Also in September, I was invited to talk to our state’s medical board, to explain more about medication-assisted treatment.

All these events were interesting. Some were enjoyable, and one, with the medical board, was transcendent.

I was a little worried about talking to this group, who make up the “doctor police.” When patients complain about a doctor, the medical board investigates. When physicians are suspected of medical incompetence, the medical board investigates. Each physician must have a license issued by the state medical board to work in our profession. By the nature of what they do, medical boards hold a great deal of power.

I was worried about my presentation, mostly because I had about fifteen minutes to explain a few decades’ worth of science, and to dispel the common myths held by most medical professionals about “methadone clinics.”

But it could not have gone better. Board members were welcoming and friendly. I did my presentation, finished just a little over time, and asked for questions. I got great questions that showed they grasped the complexities of treating people with opioid use disorder who have other challenges as well, and how best to treat them without abandoning them.

Another presentation was scheduled right after me, but the meeting halted while nearly all of the board members, who had been seated behind a raised dais, came to me to shake my hand and thank me for coming and tell me how important this work was. I was blown away by their kindness and support, and their eagerness to understand opioid use disorder and appropriate treatment.

I left there glowing. I felt like they understood, like they got what I was saying. The drive from Raleigh to Wilkesboro went by in a happy blur.

More opioid treatment providers

We have more treatment facilities available to treat opioid use disorders Since 2014, around 254 new opioid treatment programs, formerly called methadone clinics, have opened, according to a recent article in the Washington Post. [1]

Prior to that, the number of opioid treatment programs remained unchanged.

We’ve seen a push to get more primary care providers interested in prescribing buprenorphine for their patients with opioid use disorder, rather than referring all of them to specialty programs. Project ECHO at UNC started a few years ago, doing outreach to providers, and support to them in any way needed.

UNC ECHO now has three online interactive sessions per week for buprenorphine prescribers. In those sessions, cases are presented and feedback and suggestions are obtained from other providers. There’s also usually a short teaching session provided by one of the experts, on topics ranging from treatment during pregnancy to payment issues in an office-based practice. Besides providing essential guidance, providers get free continuing medical education credits.

More providers of medication-assisted treatment should mean fewer deaths from overdose. Multiple studies show reduced death risk when patients are on MAT, with an average reduction of death by three-fold.

I’m optimistic about treatment opportunities for people with opioid use disorders. I see a gradual lessening of stigma towards people who have this disorder, as well as towards the life-saving treatments for the disorder. I hope we continue to make progress in 2019.

  1. https://www.washingtonpost.com/national/health-science/some-states-add-more-methadone-clinics-to-fight-opioid-epidemic/2018/11/09/8cace992-e133-11e8-b759-3d88a5ce9e19_story.html?noredirect=on&utm_term=.59a7b585e0aa

 

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Story of a Recovering Addict

Following is an interview that I did with a recovering addict. He now has over 13 years in recovery, and has a master’s degree in addiction counseling.  His history demonstrates how NA can help an addict, and illustrates some of the main tenants of 12-step recovery.

JB: What kinds of drugs did you use?

ML: Everything. I shot cocaine, Dilaudids, heroin, quarter-grain morphine tablets, and always alcohol. Alcohol and marijuana were just a given. They were daily.

JB: Can opioid addicts get clean just using NA?

ML: Yeah. My sponsor did, and other people [have].

JB: What percentage of people in NA used opioids?

ML: Back in1982, when I entered recovery, it seemed like seventy-five percent of people in NA used opiates. Then in the 1980s, more people addicted to crack came into NA, so now I’d estimate about fifty percent or less. But there’s no numbers [statistics kept by NA].

JB: How else has NA changed?

ML: Back in the early days of NA, most addicts hit a low bottom, before coming to NA, but now, with the growth of treatment centers, drug courts, information on the internet…when my father told me I had to leave the house unless I got help, I looked in the phone book and there were only two numbers to call for help. I called the Council on Alcoholism and got directed to AA. There’s been such a growth in [addiction treatment resources]. Every family has had experience with some kind of addiction. There’s more acceptance and knowledge now. People get to NA before they hit the kind of bottom that I did. That’s a good thing.

JB: How effective is NA? Some people say that only two percent of people who go to a twelve step meeting stay clean. What do you say to that?

ML: (laughs) I’d like to know where they got their numbers.

A lot of people get their start in NA and find other means to recover…other fellowships, churchs,…it’s an individual thing. It depends on what kind of living situation the individual is in, how willing the individual is [to get clean], and what kind of recovery the people at those [NA] meetings have. It depends on how deeply they get involved in that fellowship [NA].

In my case, I went to meetings for more than a year, but I didn’t work any steps. But I stayed clean, by going to meetings and getting support from the people at the meetings. Then I moved away and didn’t have that support. It didn’t take long for me to relapse. I was around old friends I used with, old sights and sounds…It takes more than just going to meetings to be successful. There are always exceptions, though. Some people have stayed clean for years that way.

In my case, the seed was planted. I wasn’t at a point where I could honestly look at my situation. So after I skinned my ass up [experienced consequences from using drugs], I went to inpatient treatment and then a halfway house. Plus meetings [Narcotics Anonymous and Alcoholics Anonymous]. I had a little more honesty, a little more willingness. But that second time, I didn’t work all the steps. I had three and a half years clean, got to the fourth step, and I relapsed. That relapse happened when my priorities shifted from going to meetings five or six times per week to relationships, working twelve hour days, hunting and fishing. Looking back, being surrounded by people in recovery was carrying me along.

It wasn’t long. I hadn’t experienced the change that comes from working all of the steps. It was only a matter of time before the self-deception set in. How in the hell could I talk myself into thinking I could sell dope, without using it? I was dissatisfied with my job, went traveling, and met “X.” He knew I’d hauled dope out of Florida in the past, for my brother in law. He asked about my connections and asked if I could help him move some kilos. I told him I still knew a few people, but I can’t be handling the stuff. I talked myself into believing I could sell that stuff and not use it. Insane.

That led to two and a half years in state prison. This put me in a controlled environment. I knew enough about recovery and the twelve steps and the change that can happen. I’d heard enough about it that I reached out and asked people I knew in NA to get me some [recovery reading] material. That was in 1988. They didn’t have as many 12-step meetings or substance abuse programs [in jail] then like they have now. I had to reach out and ask for help. I paid “Y” [an inmate] a candy bar so he would allow me to have an NA meeting in his cell, because it was the biggest. I paid a candy bar to him each meeting. He’d never been to a meeting in his life. This was in the county jail.

When we both got to state prison, they had NA meetings there. He got real involved. He got clean and is still clean today! He has twenty-one years in recovery, works in construction, and travels the world. I went to an AA meeting a few years ago, when I was visiting a town in Alabama, and it turned out he was speaking that night. He pointed to me and said, “That man is one of the reasons I’m here.” (At this point, ML tears up and takes a pause).

I had regular correspondence with friends, who sent me recovery literature. There was a “black market” step working guide. I used it and that’s the first time I did a “fearless and searching moral inventory” of myself. I didn’t have anyone to do my fifth step with [this is the step where the addict admits to God, himself, and another human being the exact nature of his wrongs].

At this point, I was in the county jail, about to go to state prison. This guy from Minnesota was in jail for thirty days for old warrants. It turns out he had a few years of recovery. He heard my fifth step and guided me through step seven. He mentioned his dad got [was sentenced to] forty years for murder. In the late 1970’s, when I was bringing cocaine out of Miami, the guy who set me up with the Columbians was named “Z”. I would meet him in a field [to exchange drugs] and he had a young boy with him. The guy who heard my fifth step was his son!

I’d been going in the front door of this state prison for six years, as an NA member, bringing meetings to the prisoners. Now I was in that prison. I progressed on through the steps, and experienced a change in my being…a real deep change that I can’t put into words. I recognized it was the beginning of a change that would continue to occur over a lifetime.

I relapsed once more, after nearly ten years clean. I got away from people in recovery, quit doing all the things I’d done on a regular basis, like prayer and meditation, meetings, contact with people in recovery. That relapse lasted a year. I was rescued by the Macon County Sheriff’s Office. I knew I was going to die. I was waiting for the overdose, the gunshot, whatever. I had no hope.

An addict always has the potential for relapse. I don’t care who they are, where they are, how long they’ve been clean or whatever. But once I experienced change on a deep level, mentally, emotionally, spiritually, and then used drugs again…you’re not the same addict. You don’t have the hustle. You can’t be as thoughtless, selfish, and solely self-focused as you were, before you experienced that change. I knew I couldn’t use drugs successfully, and I knew it was going to kill me. But when I lost that support, when I pushed away that foundation, that God of my understanding…That allows self-deception. It might be only momentarily, but you forget. You forget who you are, and if you’re where substances are available, you’re deceived.

JB: How’s your recovery now?

ML: Awesome. If you’d asked me in 1999 how I’d be doing now, I wouldn’t have gotten close. My life today is better than it’s ever been. I’m extremely blessed and grateful to be where I’m at today. I’m blessed to have the work, the people, a wonderful fiancée … I’m blessed to be able to share my life with the people I have in my life.

JB: What kind of work do you do?

ML: I work as a counselor. I work in a jail’s substance abuse treatment program. Looking at what they have available in jails now…fully staffed treatment programs, right in the county jail! From having to pay a candy bar to hold a meeting to where they have whole dorms in the county jail to treat addiction…the change has been awesome to see.

            This addict, ML,  described how his recovery progressed over time, and how he had setbacks and relapses. Obviously, given the morbidity and mortality of active addiction, treatment professionals and addicts prefer relapse-free recovery, but for many, relapse is part of the recovery process. Many fortunate addicts are able to get back into recovery, before catastrophe occurs.

ML is also a good example of how 12-step recovery meetings can help. Addiction treatment professionals should always inform addicts seeking recovery about these meetings, and encourage addicts to go to at least a half-dozen meetings, before deciding if 12-step recovery is right for them or not.

There are many recovering opioid addicts who used 12-step resources or other counseling to become completely opioid free and were able to get through both the acute physical opioid withdrawal and the more prolonged post-acute opioid withdrawal. Therefore, it does appear that drug-free recovery may be a reasonable goal for some opioid addicts who are motivated to do the work of recovery. For addicts who find the spiritual theme of 12-step recovery unacceptable, secular recovery groups are available.

            12-step recovery is free, widely available, and proven to work. It’s still the best deal in town.

Is Your Recovery Portable?

Today I listened to a friend talk about the difficulties of keeping her recovery program going after she moved to a new area.

 From what my patients tell me, this is a common problem. Last week I had yet another patient say that her relapse started when she moved to this area from another state. She had more than eight years of good recovery, but when she moved to North Carolina, she stopped doing all the things that previously made up her recovery program: 12-step meetings, calling a sponsor, and helping other addicts. Gradually, staying clean off alcohol and other drugs lost its priority, and addiction was a distant memory. She listened to the old lie of addiction: she could use drugs now, and it would be different. Her disease told her she’d been clean so long, she knew how to keep from going back to active addiction.

 This was, of course, not true. I saw this patient shortly after she lost her job because of intravenous opioid addiction.

 Why does moving to a new area seem to begin a downward slide toward relapse for some people?

 My friend in recovery who just moved was able to describe it to me. She says it’s a starting over process, and she feels like she’s on the outside. She feels like she did when she was a newcomer to meetings. She misses the feeling of being at home in meetings, surrounded by people she knows who love her. She says getting involved in meetings in a new area is the hardest thing she’s ever done, more difficult than coming to meetings for the first time.

 She says, “I’ve done this before, and I think to myself this should be easy. It took me by surprise. The loneliness is super-dangerous. I have these dangerous feelings, like I don’t belong. It’s just like my first few months of recovery, except now I keep thinking that it should be easier, and I shouldn’t be having these feelings. In early recovery, I had that gift of desperation. I was acutely aware that the drugs brought me to that point and I had to come to meetings to stay clean. I had willingness to do whatever it took. Now I don’t feel that desperate, and have a hard time making myself go to meetings. It’s hard as hell.”

 “Plus, I don’t know who in these new meetings is working a program of recovery, and whose life is just full of drama. I don’t know who the winners are. And the formats are different, though I like them. They have topic meetings and everyone who shares stays on the topic!”

 My friend seems to be doing better than she’s feeling. The last I saw her, she was surrounding by laughter and hugs. She says she’s getting through this difficult time by sharing about her feelings, and listening to the experience of other recovering people who have moved to a new area and new meetings. She stays in touch with her old friends from previous meetings, and travels the four hours to visit these friends once or twice per month during her transition.

 I think my friend will be fine, so long as she continues to do what she needs to. Going to new meetings is difficult and staying at home would be easier, but not in the long run. Given the havoc addiction has caused in her life, she’s not willing to risk a relapse with all the heartache it brings.

A Suboxone Patient’s Success Story

I interviewed a person with a past history of pain pill addiction, and asked him about his success with Subuxone (buprenorphine). He has had astounding success in his recovery, and has been doing great for well over three years, relapse-free. Here is what he had to say.

JB: Please tell me about your experience with pain pill addiction and your experiences with buprenorphine (Suboxone).
XYZ: For me, my opiate addiction got so bad, I was taking two hundred and forty to three hundred and twenty milligrams of OxyContin per day, just to stay normal. It had gotten really, really bad. And it started out with a reason. I had kidney stones, and I was in all this pain, but then it got to the point where it solved some other problems in my life and it got out of hand. I tried a lot of different things. I went to detox, and they helped me, but it was…it was almost like I never came out of withdrawal.
JB: How long were you off pain pills?
XYZ: Even after being clean for thirty or sixty days, I would still feel bad. Bowels, stomach…really all the time.
JB: Did it feel like acute withdrawal or just low grade withdrawal?
XYZ: No, it depended on the point…I’d try to fix it myself, sometimes, and I would just put myself back where I was. It got to the point where I was making myself sicker and sicker and sicker. And then I got off of it, and stayed off of it for a hundred and twenty days, I guess…but still just sick. Just miserable, and not feeling right. I was miserable. I wouldn’t eat, I was losing weight…
It [buprenorphine] gave me something that replaced whatever was going on in my head physically, with the receptors. It took that [prolonged withdrawal] away, to the point that I felt well. All that energy I would spend getting pills…and I was going to the doctors almost daily. Because taking that much medicine, nobody would write me for that much, so I had to doctor shop.
JB: Did you go to the internet [to order pain pills]?
XYZ: I did. But on the internet, the only things that I found were hydrocodone, so it would take a lot of those. I was concerned about my liver, from the Tylenol in them.
My only life was going to the doctors, figuring out what pharmacy I could use. I had a whole system of how many days it could be between prescriptions, what pharmacy to go to. It was sick. I was just trying to not get sick.
JB: And you were working during that time?
XYZ: Yeah! I was working, if you want to call it that. I wasn’t a very good employee, but I held a job. I was a regional vice president for “X” company. I traveled a lot, so I had new states where I could see new doctors. That was bad. When I came off the road, I owed $50,000 in credit card bills.
JB: And your wife didn’t know about it?
XYZ: No. It all came tumbling down. And I had gotten into trouble, because they were company credit cards, and they wanted the money back! So, all of the sudden my wife found out that not only do I have a pain pill problem, but we’re $50,000 short, and I wasn’t very ethical in the way I got the money, because it really wasn’t my credit, it was my company’s credit card.
JB: So addiction made you do things you wouldn’t do otherwise?
XYZ: Absolutely. I lied to people, I took money from people, I ran up credit cards tens of thousands of dollars, and really put my family in serious jeopardy at that time. But buprenorphine took away that whole obsessive-compulsive need for pills, made me feel better, and took away all the withdrawal symptoms at the same time. I didn’t worry about it.
To be honest, I was such a hypochondriac before. I haven’t been sick in years now. I haven’t had a backache or headache that ibuprofen didn’t cure [since starting recovery]. I was fortunate it was all in my head. I would milk any little thing. I had two knee operations that probably could have been healed through physical therapy, but I was all for surgery, because I knew I’d get pain pills.
JB: That’s the power of addiction!
XYZ: I did some research about this [meaning buprenorphine].
JB: How did you do your research?
XYZ: Online. Actually, I had some good family members, who did some research and brought it to me, because they were concerned for me, and they brought it to me and said, “Hey, there’s a medicine that can help. Call this number,” and I found places out there that would do it [meaning Suboxone], but my concern was the speed that a lot of them were doing it. A lot of them said, OK come in, and we can evaluate you, and after a week you’ll be down to this, and after a month you’ll be down to this.
This was in 2005. And when I asked them what their success rate is, it wasn’t very high. It was something like twenty percent of the people who were doing it [succeeded]. So when I’d finally gotten a hold of “X,” [receptionist for Dr. Hall], she saved my life over the phone. Because she said, you can come tomorrow, and she said that whatever it takes, they’ll work with you. And I felt good about going to a place where it wasn’t already determined how long it would take. Because I already knew how I was feeling after I would come off of opiates. I didn’t want to do that again.
I saw Dr. Hall and felt better within twenty-four hours, although it took a little while to get the dosage right. I think we started off at a lower dose, then we went up on the dose and it kept me so level. I had no symptoms. It cured my worst withdrawal symptoms, my stomach and my bowels.
There’s always a kind of stigma in the rooms [12-step recovery meetings] because I’d been in NA for a little bit of time then [he’s speaking of stigma against medication-assisted treatment]. You realize who [among addicts in NA] is die-hard, one way to do recovery, and who is willing to be educated about some things and understand that there’s more than one way to skin a cat.
And I was fortunate that I had a sponsor at that time, and still do, who was willing to learn about what exactly it was, and not make me feel guilty about it. It wasn’t necessarily the way he would do it, but he was a cocaine addict, so he didn’t understand that whole part of it.
He said, “Your family’s involved, you’ve got a doctor that’s involved, your doctor knows your history. If all these people, who are intelligent, think this is an OK thing, then who am I to say it’s not going to work?” He was open-minded. And there are not a lot of people I would trust right off the bat [in recovery], that I would tell them. [that he’s taking Suboxone]. I’ve shared it with some people who’ve had a similar problem, and told them, here’s something that might help you. I always preface it with, [don’t do] one thing or another, you’ve got to do them together. You have to have a recovery program and take this medicine, because together it will work. Look at me. I’m a pretty good success story.
One of my best friends in Florida called me, and I got him to go see a doctor down there, and he’s doing well now. He’s been on it almost eleven months now and no relapses.
To me, it takes away the whole mental part of it, because you don’t feel bad. For me, it was the feeling bad that drove me back to taking something [opioids] again. Obviously, when you’re physically feeling bad, you’re mentally feeling bad, too. It makes you depressed, and all of that, so you avoid doing fun things, because you don’t feel good.
Once I trained myself with NA, how to get that portion of my life together, to use those tools, not having any kind of physical problems made it that much easier to not obsess.
JB: So, how has your life improved, as a result of being on buprenorphine?
XYZ: Well, the most important thing for me is that I’ve regained the trust of my family. I was the best liar and manipulator there was. I’d like to think of myself as a pretty ethical and honest person, in every aspect of my life, other than when it came to taking pills.
JB: So, you regained the trust of your family, felt physically better…
XYZ: I gained my life back! Fortunately, I had enough of a brain left to know it had to stop. Once I started on buprenorphine, it gave me back sixteen hours a day that I was wasting. That’s when I decided I really don’t want to jeopardize my recovery, by going out and looking for a job again [he means a job in corporate America, like he had in the past], because I’ve got this thing, this stigma…they’re going to check a reference and I’m screwed. I’m not going to get a job doing what I was doing for the same amount of money.

…to be continued