opioid addicts
Taylyr Williams, 27, sits on her bed in the Norman Oxford House where she has lived since January. Williams is one of only 40 Oxford House residents statewide taking prescribed medication as part of her recovery from opioid addiction. (Whitney Bryen)

(Editor’s note: This story was authored by Whitney Bryen of Oklahoma Watch and appears here in accordance with the non-profit journalism organization’s republishing terms.)

Addiction-recovery homes across Oklahoma are turning away opioid addicts who are trying to escape their addiction by taking medications considered highly effective for recovery.

Oxford House, one of the state’s largest networks of recovery homes for drug and alcohol addiction, is trying to convince more of its residences to accept applicants who are taking prescription drugs that curb cravings and withdrawal symptoms, like Suboxone or methadone. But resistance is strong.

Each of the 110 Oxford Houses in the state – there are 2,400 nationally – is autonomous, and residents vote on whether to allow applicants to live there.

Because Oxford Houses are sober-living homes (meaning they discourage the use of any addictive drugs or alcohol), many residents oppose letting in newcomers who are taking drugs like Suboxone, which are designed to help transition them out of opioid addiction. Residents are concerned that the presence of Suboxone and methadone, which also can be addictive, will jeopardize their sobriety.

Among 835 residents in Oxford Houses across the state, about 40, or less than 5 percent, are on medication-assisted treatment involving Suboxone or methadone, according to Dan Hahn, who coordinates statewide outreach for the nonprofit. This is up from zero 11 months ago.

Concern about the rejections has reached state government officials.

The Oklahoma Department of Mental Health and Substance Abuse Services obtained a $7.3 million federal grant last year to address the state’s opioid crisis, which has led to hundreds of fatal overdoses each year. (In 2016, opioids were responsible for 444 deaths, the National Institute on Drug Abuse reports.) A small portion of the grant, $140,000, went to Oxford House to help educate residents about the value of medication-assisted treatment.

Katie Guess, 36, (right) raises her hand during a vote taken at a house meeting at Oxford House Boomer in Norman on Oct. 9, 2018. Oxford Houses require an 80 percent approval from residents to allow new applicants to move in. (Whitney Bryen)

“One of the greatest strengths of Oxford House is also one of its weaknesses,” the grant application states. “Oxford House functions as a true democracy and new members are voted in (and sometimes out) of a house with an 80% majority vote.” But “the stigma and lack of clear understanding … usually results in a ‘no’ vote for a (medication-assisted recovery) person.” The application, however, noted there are signs of change.

Jeff Dismukes, a spokesman for the mental health department, said sober-living conditions are crucial to a successful recovery. “Going back to an environment where people are using isn’t conducive to recovery. It’s not an option,” he said.

Some residents concerned

Wendy Knapp has spent decades in and out of recovery programs for drug and alcohol addiction. Today, the 56-year-old fast-food worker is three years sober and living in Oxford House Boomer in Norman. She is confident that this time her recovery will stick.

After each relapse, Knapp quit cold turkey, relying on abstinence, sober-living homes and peer-support groups to stay clean. So when a woman who was using prescribed medication to treat her opioid addiction applied to join the house this summer, Knapp voted against her, and the woman was turned away.

“We don’t want that here,” Knapp said. “We talked about it, and we just don’t agree with that in this house.”

The feeling is similar at Oxford House Amina in Ardmore, which is dealing with the dilemma. Resident Natasha Knight said recently that the house was about to interview an applicant who was on medication assistance and that she likely would be rejected.

“For some people in the house, yes, it’s a problem,” Knight said. “I went to a seminar about a month ago that opened my eyes, but before that I was completely against it. She’ll probably get voted down because of that.”

The resistance to admitting people who are using medication-assisted treatment for opioid dependence is rooted in a culture of total abstinence, found in many peer-support programs like Alcoholics Anonymous and Narcotics Anonymous.

Christina Deaton, 32, reviews financial records during a house meeting at Oxford House Boomer in Norman on Oct. 9, 2018. Like most Oxford Houses statewide, Boomer does not have any residents on medication-assisted treatment such as Suboxone or Methadone. (Whitney Bryen)

On its national website, Oxford House says, “In its simplest form, an Oxford House is a democratically run, self-supporting and drug-free home.” Residents pay rent and expenses, and typical homes contain anywhere from six to 16 residents, which means in smaller houses one vote is enough to block an applicant from moving in.

In 2010, Oxford House updated its policy from a prohibition on medication-assisted treatment to allowing residents to make the call.

“We’re trying to maintain the integrity of our model, but also be progressive because we know things are changing,” Hahn said.

Mixed messages

Much of the controversy surrounds the growing use of Suboxone, which addiction specialists say is effective when combined with counseling and, eventually, peer-support programs. Suboxone is a combination of the opioid buprenorphine and the drug naloxone, which blocks the effects of other opioids and deters abuse of the prescription.

Oklahoma doctors have written more than 169,000 prescriptions for medications containing buprenorphine so far this year, according to data from the Oklahoma Bureau of Narcotics and Dangerous Drugs Control. That’s up from roughly 145,000 in 2014.

● It is sold under the brand names Suboxone, Subutex, Zubsolv and Probuphine (in some cases it is combined with other drugs).
● It is one of the most commonly prescribed medications for the treatment of opioid addiction.
● It is an opioid.
● It bonds to the same receptors as oxycodone or heroin but is much safer.
● It takes days to peak and sustains for 10 to 60 hours, so there aren’t crashes or cravings.
● It can be abused.
● Some patients wean themselves off it over time, while others stay on it indefinitely.

Dr. Layne Subera is one of more than 250 practitioners in Oklahoma certified to prescribe buprenorphine. Physicians must seek a waiver from the Drug Enforcement Administration and have a cap on the number of patients they can treat with the drug. Subera, a family physician in Skiatook, just north of Tulsa, said it is challenging to find residential programs for his 140 patients on medication-assisted treatment.

Many sober-living homes, mental health facilities and peer-support groups across the state reject patients on these medications because they don’t understand the treatment’s value, he said.

“A lot of people don’t like the idea that we’re fighting an opioid addiction with opioids, but I like to think of it more like fighting fire with fire,” Subera said. “It’s not perfect, but it’s the best we have right now.”

Hahn, of Oxford House, said he is working to educate residents about medication-assisted treatment and promote “multiple pathways to recovery.” He said these efforts are helping sway opinions in many urban-area houses, but perceptions are harder to shift in rural locations.

Since late 2017, the majority of patients on medication-assisted treatment who have applied to Oxford House have been accepted, Hahn said. But residents said many don’t even apply to get into a house because of the homes’ reputation for turning people away.

Hahn said people using medication for treatment are not a good fit for every home. They should be redirected from homes where residents – about 100 of them now – are in recovery from Suboxone abuse, he said.

New houses, those with high turnover or transitioning leadership should also be ruled out. Residents on medications put more responsibility on house leaders such as forcing them to perform daily pill counts, he said.

Tulsa’s Oxford House Green Country was one of the first in Oklahoma to accept someone on Suboxone. Resident Shannon Kelly, who has lived in the house for 10 months, said two women on medication assistance have moved in and fit in well.

Taylyr Williams, 27, was not on medication in January when she applied to Norman’s Oxford House Elmhurst. Williams had abused opioids on and off for about eight years, starting with Oxycontin and graduating to heroin. She tried to pull herself out of the cycle, but without any treatment programs or support groups to rely on, she relapsed repeatedly. She even relapsed once after moving into an Oxford House. She decided to seek additional help.

“I watched my sister who was even worse off than I was, and then she went on Suboxone and it was successful for her,” Williams said. “I used to be against it, too, but that changed my entire outlook on it.”

Williams waited two months for an appointment at a Norman clinic, where she was eventually put on a treatment plan that included Suboxone. Since Williams was already living in an Oxford House, she was required to get approval from her housemates to bring her daily dose into the house. She spoke to them during a house meeting and they approved her request. Williams said her house is very open-minded and accepting about her treatment.

“The meds help with the cravings so I don’t really even think about it that much anymore,” Williams said. “They made a huge difference for me in staying sober this time.”

Despite testimonials like those, suspicions persist.

Troy Rouse, who lives in Oxford House Rockford in Ardmore, said he is weary of anyone taking medication after watching his sister abuse her Suboxone prescription. Rouse said he doesn’t think prescription treatment is a good idea for any addict and “if someone came to the house, I’d let them know that pills like those wouldn’t be good for any addict.”