Stigma: the Biggest Barrier to Medication-Assisted Treatment

Buprenorphine becoming more acceptable, but much work still to be done

By Jason Snyder, Director of Strategic Partnerships, Pinnacle Treatment Centers

A new City of Philadelphia ad campaign confirms what addiction treatment research has long established.

“Bupe works.”

Here’s to hoping the amplified message being delivered via social media posts, videos and billboards can cut through the cacophony of stigma and misinformation to reach those for whom the medication holds such tremendous promise for not only recovery from the disease of addiction but for life itself.

If you work in the addiction treatment world or have followed even peripherally the opioid overdose death epidemic plaguing the United States, you’ve heard of buprenorphine, often called “bupe” for short. It is a medication used to help people who are addicted to opioids like heroin, fentanyl and oxycodone stop using them. Along with counseling, buprenorphine (as well as methadone and naltrexone) is considered the gold standard for treating opioid use disorder. The medication-counseling combination is referred to as medication-assisted treatment (MAT).

Buprenorphine was approved to treat addiction in 2002, and studies continue to demonstrate its superiority versus abstinence-based models in keeping patients who are addicted engaged in treatment longer and free of illicit opioid use. Remarkably though, it’s only now beginning to become more available and gain broader social and clinical acceptability. Yet even with this progress, there is still a long way to go on these fronts. Hence, Philly’s ad campaign.

Although federal regulations limit the number of patients for whom healthcare providers can prescribe buprenorphine, the biggest barrier to the medication has been stigma. To see that stigma, look no further than the ad campaign itself.

Kevin Kinzie is proudly and prominently featured in the ad campaign. He has been in recovery from opioid addiction eight years after more than 20 stints in traditional rehabs. He attributes his recovery in large part to buprenorphine.

“Even today, you’re not looked at like you’re sober if you’re on (buprenorphine) or you’re on methadone – especially methadone,” Kinzie told Philly Voice. “A lot of people don’t accept it, but some people do. But I had tried for so many years and failed. All of a sudden, I go to this and here I am.”

Consider that statement – “But I had tried for so many years and failed.”

I would argue it wasn’t Kevin who failed but instead it was the system that failed him. I wonder how many times during those more than 20 trips to rehab did those admitting him suggest there may be a better, more effective route for him. I’d bet not many.

In my experience with addiction, including my own addiction to opioids, the opioid overdose deaths of both of my siblings and my connection to the recovery community today, those struggling with opioid use disorder who could benefit from MAT are too often steered away from it based on someone else’s philosophy, an all-or-none mentality – “You either take nothing or you’re not ‘clean,’” or, “I did it without medication, so you can, too.”

It’s very easy to gamble someone else’s life based on your philosophy. It’s also immoral.

And make no mistake, this is life or death.

Medication is not part of my story of recovery, and there are people today who have found a life of recovery without medication. But for many, MAT is essential.

I think of my brothers every day, and I know that my parents and I would much rather have Todd and Josh alive today using a medication to give them a fighting chance than have them lying dead beside each other in a graveyard in Portage, Pa., which is where they are today.

We must use every tool at our disposal to treat people with the disease of addiction, especially what science time and again has validated as the gold standard. I encourage you to better understand the science of addiction and treatment.