Jason Thompson tried again and again to beat his heroin addiction, but nothing worked — not rehab, not self-help meetings, not even prison time.
Then, about a year ago, the 37-year-old from Ottawa, Ill., turned to what researchers call the gold standard of heroin treatment. He started taking methadone, a medication that controls drug cravings and withdrawal symptoms because it is also an opioid.
That characteristic has led critics, including many inside the recovery movement, to denounce methadone and its close cousin buprenorphine as sham treatments that encourage users to surrender to their addictions rather than conquer them.
Thompson, who drives more than two hours round-trip to a Downers Grove clinic for his medication, doesn’t see it that way.
“I’m in the boxing ring with a champ that I can’t beat,” Thompson said. “There ain’t no sense in fighting no more.”
As the nation struggles with an unprecedented epidemic of opioid addiction, the federal government aims to increase access to methadone and buprenorphine, now taken by hundreds of thousands of Americans. The government has spent $94 million to allow health centers to serve 124,000 new patients, and changed a rule to allow doctors to expand their caseloads.
But the stigma that lingers over these treatments continues to limit their availability and appeal, leading many to enroll in abstinence-based programs that research has shown to be less effective than medication-assisted therapy.
“People from 12-step groups basically create some version of shame that says, ‘I’ve gone through hell, and anyone who has not followed in this righteous path is not really in a state of recovery,'” said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. “It’s fascinating how people get marginalized so easily.”
Some patients, though, are beginning to speak about the positive experiences they’ve had with methadone and buprenorphine, saying the medications have allowed them to achieve a recovery that is as legitimate as anyone’s.
“I consider myself to be clean,” said Kim Campin, 53, a suburbanite who has been on methadone for more than a decade. “The whole addict mindset is no longer part of me. I consider the addiction such a small part of my life now.”
Painkiller turned treatment
Methadone is a long-lasting opioid developed by German scientists before World War II. First used as a painkiller, it became an addiction treatment in the 1960s as heroin use rapidly expanded.
Like heroin, Methadone binds to receptors in the brain, eliminating the agonizing symptoms of withdrawal without producing much of a high. Patients generally take it at a clinic every day until they earn enough trust to receive take-home doses, a system meant to curb abuse.
The medication is strong enough to be deadly if misused: The Centers for Disease Control and Prevention tallied 3,400 methadone overdose deaths in 2014, compared with 27,000 from heroin and prescription pain pills.
Buprenorphine is supposed to be a safer alternative. Another opioid painkiller, approved in 2002 as an addiction treatment, it is not as potent as methadone and usually comes in combination with naloxone, a chemical meant to trigger withdrawal if the medication is abused.
Doctors screened by the U.S. Drug Enforcement Administration are allowed to prescribe buprenorphine out of their offices. They’ve long been limited to 100 patients each in an effort to avoid the “pill mill” phenomenon that has plagued opioid painkiller use, but just last week the government announced it would raise the ceiling to 275 patients.
The CDC doesn’t track buprenorphine deaths, but they appear to be far less common than methadone fatalities: Researchers in New York last year tested the blood of drug overdose victims and found that only 2 percent had buprenorphine in their systems.
Experts say the medications are safe when used correctly, and that their effectiveness has been established by dozens of studies. Patients who take them are much more likely to stay away from heroin than those who enroll in abstinence-based programs, which, according to some studies, have failure rates greater than 80 percent.
Dr. Gavin Bart, head of addiction medicine at Minnesota’s Hennepin County Medical Center, said that’s because methadone and buprenorphine don’t just block withdrawal — they reset the brain’s chemistry after drug abuse throws it into disarray.
“The medications are actually serving to correct something,” he said. “Abstinence-based treatment doesn’t allow brain functions to return to normal to the extent that medications can. That, in large part, explains the difference.”
The federal push has focused on buprenorphine, but Richard Weisskopf, who oversees methadone programs at the Illinois Department of Human Services, said that medication is also underused. While the state has about 11,600 methadone patients, many more are turned away for a lack of funding, he said.
“We need more (capacity),” he said. “People are coming in to seek treatment whether they leave their name on a waiting list or not.”
Privately run methadone clinics have grown slightly, but operators say community resistance has limited their reach. Consider what happened in Berwyn in 2008.
The city granted Elizabeth Buonauro permission to open a methadone clinic in a medical building, only to reverse itself after a massive outcry from residents worried that drug users would flock to their neighborhood.
Buonauro sued in federal court, saying the decision violated the Americans with Disabilities Act, and after nearly four years of litigation a federal judge ordered the village to allow the center to open. But that never happened: Buonauro’s business partner decided to retire, and she retained too much bitterness over the way she was treated.
“More people are talking about methadone, but people still don’t want it anywhere in their backyard,” said Buonauro, who runs another clinic in Evanston. “We think (addicts) should have a place to go, but we don’t want them close to us.”
‘Still a dependency’
Concerned neighbors aren’t the only ones unnerved by methadone and buprenorphine. Many in the recovery movement also take a dim view of medication-assisted treatment.
Ralph Harris of Chicago’s Campaign for a Drug Free Westside said doctors and clinics that provide the medications have a financial interest in making sure their clients never achieve abstinence.
“It’s still a dependency,” he said. “It’s a dependency on a legal substance as opposed to an illegal substance. It doesn’t really promote overall wellness.”
Former heroin user Brad Gerke said his experience with Suboxone — a brand name for buprenorphine and naloxone — was a fiasco: He often sold his take-home doses to buy heroin and continued to abuse alcohol and crack cocaine.
When a jail stint forced him to come off the medication, he said, his withdrawal symptoms were far worse than they had been with heroin. He said his drug problems continued until he committed to the 12 steps and received the “spiritual awakening” that allowed him to achieve sobriety.
“That needs to happen,” said Gerke, 32, who works for the abstinence-based Banyan Treatment Center in Naperville. “That can’t happen when my mind is fogged by Suboxone.”
Similar stories are compiled on the online comment board SubSux.com, created by a former buprenorphine patient from Winston-Salem, N.C. The site’s members have written more than 90,000 posts chronicling their bad experiences and advising others on how to wean themselves from the medication.
“I was dosing just to complete tasks,” said the site’s creator, a 49-year-old who goes by the screen name Ratch. “I would get a small boost then fade fast. I also (realized) that I was stoned/high all the time. It was just trading one drug for another.”
Even some who’ve found value in the medications say they’ve faced pressure to abandon them.
Zach Siegel, 27, a Chicago journalist, said he left detox with a Suboxone prescription four years ago when he was trying to kick his heroin habit. But after entering a sober living program run by the Hazelden Betty Ford Foundation, he was encouraged to stop taking the medication.
“I thought this was what you were supposed to do,” he said. “It’s sort of an echo chamber where everyone on Suboxone is trying to get off, (thinking) you don’t want to be on it for a long time.”
He tapered off the medication and made it through the program, only to return to heroin. It took another expensive stint in rehab, paid for by his parents, before he attained a grasp on sobriety — an ordeal he said might have been avoided had he stayed on Suboxone.
Dr. Marv Seppala, chief medical officer of Hazelden Betty Ford, said the foundation has since changed its policies and recommends that all opioid patients take buprenorphine. It was not an easy transition; some within the organization accused it of abandoning its long-held allegiance to the 12 steps.
But Seppala said educational programs focusing on the overdose deaths of people who had attempted abstinence quieted the resistance.
“When you use the data, when you tell people the whole story, that’s what started to win them over,” he said.
Positive stories rare
While cautionary tales about methadone and buprenorphine are easily found online or in the meeting rooms of self-help groups, optimistic accounts are harder to come by.
“Part of the problem is that (people with) success stories on methadone don’t want (others) to know it,” Parrino said. “Revealing that they’re using methadone is still quite shameful.”
But at the Tribune’s request, the Center for Addictive Problems, a clinic that serves about 1,000 people in Chicago and Downers Grove, offered patients the opportunity to detail their experiences to a reporter.
Five responded, sharing stories of how methadone had put an end to years of life-threatening heroin abuse, allowing them to work and reconnect with their families. Some had been on it for more than a decade, others for less than a year, and they had varying opinions about how long they wanted to continue.
“Two or three years, max, I think you should be tapering down and getting yourself off,” said Josh, 34, a Joliet man who has taken methadone for 10 months. “People who are on it for seven or eight years, I think that’s way too long. That’s using methadone to stay high rather than using it to get off heroin.”
Thompson, though, had no end date in mind. He had used heroin off and on since age 20, and after many futile attempts to quit, he made a near-desperate decision to try methadone.
The medication keeps him steady and engaged with life, he said. His girlfriend, Trisha Davis, said he has become an entirely different person.
“It’s like night and day,” she said. “He’s not a zombie anymore. There’s none of that at all. He’s just a normal, average guy. If you didn’t know he was taking it, you wouldn’t have any idea.”
Thompson visits the clinic three times a week, and the long drive can be a hassle. But whenever he contemplates stopping, he said, he remembers the chaos of his heroin days.
“I’m sure I’ll wake up one day and be like, ‘It’s time to get off it,’ but I don’t think I’m there yet,” he said. “If that never comes to me, I’ll stay on it forever.”
Twitter @JohnKeilman
