Suboxone.” A patient had arrived at his St. Charles clinic recently on her sixteenth birthday, only to learn that she’d acquired hepatitis C from injecting black-market Subutex.
It was simple observation bias: MAT opponents failed to see the distinction between people who abused buprenorphine and those who took it responsibly. “They don’t see all the patients I have who are going through college, getting their master’s degrees, getting jobs and their kids back, some of them drug-free now for ten or twelve years,” Van Zee said.
A few of Van Zee’s long-term patients had tapered from 16 milligrams of Suboxone to as little as a half-milligram a day, but he hesitated to wean them entirely because, in his experience, it often led to relapse. Though there was scant data about the efficacy of long-term Suboxone treatment, one study showed that 50 percent of users relapsed within a month of being weaned from the drug; the lower the dose at the time of weaning, the better the outcome. Another study, conducted over five years, showed that roughly a third of buprenorphine patients were drug-free after eighteen months, a third were still on MAT, and most of the remainder were back on heroin or illicit opioids.
When a person is weaned too soon, his or her relapse feeds the perception that MAT is ineffective, reinforcing unfair and faulty notions about the treatment, said Nora Volkow, the NIDA official. “All studies—every single one of them—show superior outcomes when patients are treated” with maintenance medications such as buprenorphine or methadone, Volkow told me. She pointed out that most patients buying black-market Suboxone are really trying to avoid dopesickness—“and that is so much safer for them than going back to heroin.”
One Roanoke woman was so desperate to avoid relapse that she prepared for an upcoming two-week jail stint by stuffing a vial of Suboxone strips inside her vagina, knowing local jails didn’t allow MAT. “Then, in the middle of the night, she pulled the bottle out, took one, then quickly put it back,” said her Roanoke psychiatrist and MAT doctor, Jennifer Wells, who treats indigent pregnant women before and after delivery.
That patient’s continued recovery, Wells added, “speaks to the fact that MAT works. And that patients will go to any length not to relapse. They know what they need!”
But the divide between MAT opponents and proponents only deepened as I followed the travails of the Hope Initiative and users like Tess. While treatment providers, police, and family members were arguing about the best way forward, lives hung perilously in the balance.
*
It was hard being Tess. After four NA meetings, she stopped wanting to go, often texting me just as I was leaving to pick her up. The baby was sleeping, or she was too tired because he’d kept her awake the night before. His father was in jail after an alcohol-related arrest. And though his mother stepped in often to babysit, she was planning to move to North Carolina and hinted that she wanted to take her grandson with her.
Having grown up in an alcoholic household, I knew what it felt like to live on the periphery of addiction—the potential danger of being neglected, taken advantage of, or even raged against. And being with Tess sometimes brought up memories of a much darker time. I worried about her son and felt sorry for him. There were instances when journalistic boundaries blurred, such as the night Tess texted me from an unknown location:
Can yoi please come gwt me.
I was in the middle of organizing taxes, with the help of my spreadsheet-whiz niece, and didn’t see the text immediately. An hour later, I weighed what to do, talked to my husband, and ultimately forwarded Tess’s plea to both Patricia and Jamie Waldrop, who was Tess’s Hope volunteer. The next time I saw Tess, neither of us brought it up.
It was February 2016, and Patricia believed Tess was using again—items from the house started vanishing, including a laptop, and she discovered empty heroin baggies in her bathroom trash—but Tess vehemently denied it.
Family stress was high. Tess’s parents had different opinions about the best course of treatment, and Tess believed her siblings looked down on her as the black sheep. Her dad, Dr. Alan Henry, begged her to enroll in a twelve-month residential recovery program at the faith-based Roanoke rescue mission, but the mission banned stimulants of all kinds, from cigarettes to MAT, and Tess was not only still on buprenorphine and a heavy smoker, she was also a proud atheist. “The