Across Oklahoma, many sober living and recovery houses are turning away individuals seeking a safe place to live and maintain their sobriety. The reason for this is the use of medication prescribed for extended recovery. Controversial medication-assisted treatments, such as Suboxone, Methadone, and Subutex, are causing some providers to deny access to recovering addicts who rely on these medications to overcome severe opioid addiction.
Oxford House, the largest provider of recovery housing in Oklahoma, operates 110 sober living houses in the state. Established in 1975 in Maryland, Oxford House now manages nearly 2,400 homes nationwide. Each Oxford House follows the principles of the 12-Step program but is independently managed, which allows each house to decide whether to accept residents on medication-assisted treatment programs. Despite Oxford House’s commitment to evidence-based treatment, some house managers are reluctant to admit residents who are still using medication.
The debate over medication-assisted treatment (MAT) remains divisive within the recovery community. Many are concerned about the potential for addiction to medications like Suboxone and Methadone, leading to polarized opinions on whether residents should be completely substance-free or if these medications are effective in helping individuals stay off more dangerous substances. Currently, less than 5% of Oxford House residents in Oklahoma are on MAT, a significant increase from last year’s figure of zero, reflecting evolving attitudes toward these treatments.
In 2017, the Oklahoma Department of Mental Health and Substance Abuse Services received a $7.3 million federal grant to combat the state’s opioid crisis, which has claimed over 2,500 lives in the past three years. Of this grant, $140,000 has been allocated to Oxford House to support residents and promote the benefits of medication-assisted treatment.
Oxford House operates democratically, requiring an 80% majority of current residents and managers to approve new applicants. While acceptance of MAT residents is increasing, a clear stigma remains, with ongoing concerns about how the presence of additional substances might impact other residents’ recovery. Given the abstinence-based foundation of the 12-step program, it is understandable why some residents might oppose allowing those on MAT into their communities.
Oxford House
The first Oxford House was established in 1975 in Silver Spring, Maryland, to provide a sober and supportive environment for those following the 12-step program and others committed to sobriety. All Oxford Houses operate democratically and are supported by the umbrella organization, a 501(c)(3) non-profit. Each house accommodates six to fifteen residents and is segregated by gender.
Suboxone in Oklahoma
Suboxone, which combines the opioid agonist buprenorphine with the opioid antagonist naloxone, has been recognized as a promising treatment when used alongside regular counseling and peer support. In Oklahoma, more than 169,000 patients were prescribed medications containing buprenorphine in 2018, a significant increase from approximately 145,000 in 2017, according to the Oklahoma Bureau of Narcotics and Dangerous Drugs Control. Buprenorphine, the controversial component of Suboxone, is also available under the brand names Subutex, Zubsolv, and Probuphine.
To prescribe Suboxone and other buprenorphine-based treatments, practitioners must obtain a waiver from the Drug Enforcement Administration and limit the number of patients they can treat with these medications. Currently, over 250 practitioners in Oklahoma are authorized to prescribe buprenorphine. Dr. Layne Subera, who treats 140 patients with medication-assisted treatment, addresses the stigma surrounding these treatments:
“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. It’s not perfect, but it’s the best we have right now.”
Certain Oxford Houses should be cautious about accepting residents on medication-assisted treatments. For instance, nearly 100 residents in Oklahoma’s Oxford Houses are specifically recovering from Suboxone abuse. Additionally, homes with high turnover rates may not be suitable. In houses where MAT residents are accepted, it might be beneficial for managers to conduct daily pill counts.
What is Suboxone?
Suboxone is a medication frequently used to treat opioid addiction, including dependencies on substances like heroin, morphine, and oxycodone. It combines two drugs: buprenorphine, an opioid agonist, and naloxone, an opioid antagonist. This combination allows individuals to gradually taper off their addiction while reducing the intensity of withdrawal symptoms.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), while buprenorphine can produce effects similar to those of opioids, such as mild euphoria, these effects are significantly weaker. Additionally, higher doses of buprenorphine do not enhance these effects, which helps to limit the potential for misuse and dependency.
Buprenorphine
Approved for clinical use in October 2002, buprenorphine is a key component in medication-assisted recovery. It was the first medication authorized for treating opioid dependency that can be prescribed by physicians. As a partial opioid agonist, buprenorphine mimics some effects of opioids, such as euphoria and respiratory depression, but these effects are much milder compared to those of heroin and methadone.
Naloxone
Naloxone is designed to reverse opioid overdoses. As an opioid antagonist, it binds to opioid receptors to block the effects of opioids. When combined with buprenorphine in Suboxone, naloxone helps prevent abuse by ensuring that increasing doses do not result in a stronger high.
Oklahoma’s Opioid Crisis
A significant aspect of Oklahoma’s opioid crisis is its increasing rate of incarcerated women, which is the highest in the nation. Approximately 85% of these women are mothers, and the state is just beginning to acknowledge the adverse effects of this situation and the urgent need for criminal justice reform. In 2016, Governor Mary Fallin called for changes to prevent family separations and address this issue.
Robin Steinberg, the executive director of Bronx Defenders, a New York-based nonprofit providing legal services to low-income clients, relocated to Oklahoma to assist residents there. Her initiative, “Still She Rises,” launched in November 2016, aims to tackle the significant barriers to achieving fairness in the legal system for addicts who cannot afford quality treatment. Oklahoma faces limited safety nets, including minimal cash assistance, few childcare subsidies, and inadequate healthcare options for low-income families. Additionally, the state has rejected key provisions of the Affordable Care Act and has one of the highest infant mortality rates in the country.
Many addiction treatment centers in Oklahoma have lengthy waiting lists, sometimes extending for months or even years. Publicly funded treatment centers are often the only option for those in poverty. “Still She Rises” is working to provide female offenders with more treatment options. One notable achievement was the bipartisan passage of two bills: one that reduced penalties for low-level drug and property offenses for low-income offenders, and another that redirected savings from drug arrests and incarceration into drug rehabilitation programs.
Although still in its early stages, the program has shown promise. According to Terri White, commissioner of the Oklahoma Department of Mental Health and Substance Services, outpatient mental health and substance abuse treatment costs about $2,000 per person per year, compared to roughly $19,000 per person per year for incarceration. Taxpayers have recognized the benefits of a more compassionate approach, both for individuals and for state finances.
“Our state prisons are filled to well over capacity, so it is crucial that we make some changes to our criminal justice system.” – Mary Fallin, Governor of Oklahoma
Oklahoma’s Childhood Crisis
A 2014 study conducted by the University of Oklahoma’s Department of Sociology examined the impact of Oklahoma’s high rate of incarcerated women on the state. Researchers interviewed individuals from various prisons, focusing on the mothers’ relationships with their children, including aspects such as contact frequency, child placement, and issues affecting the children.
The study revealed that many incarcerated mothers were deeply concerned about their children’s placement, age, health, and the quality of care provided by either family members or state-appointed guardians. Common issues included unstable living conditions, separation of siblings, and worries about the children’s well-being. The researchers recommended that the state focus on addressing sibling separations, unsafe living environments, and the needs of caregivers who may be ill or elderly.
Additionally, fostering mother-child relationships during incarceration could alleviate stress for both the mothers and their children, helping to address the emotional trauma caused by their separation. Facilities and programs could enhance child-friendly visitation areas to minimize this trauma.
A recent voter-approved measure aimed at reducing incarceration rates included reclassifying drug possession from a felony to a misdemeanor. However, this measure has had limited success in reducing the number of individuals imprisoned for possession. In the latter half of 2017 alone, 882 individuals were admitted to Oklahoma prisons for possession of a controlled substance, making it the leading offense for prison admissions in the state.
During the 2018 legislative session, further reforms were introduced, including reduced penalties for minor property crimes and the option for sentenced individuals to petition for reduced charges. These changes aim to address the rising costs of incarceration for victimless crimes and mitigate the severity of sentences that disproportionately affect low-income individuals. Oklahomans for Justice Reform assisted nearly 50 inmates in petitioning for the commutation of lengthy sentences. The 2018 parole board reviewed 477 commutation applications and advanced only 19 to the governor’s approval stage.
Next Steps
For assistance in organizing medication-assisted recovery for a loved one, consider seeking help from trained professionals. For alcohol rehab in Oklahoma, Sunrise Recovery offers a drug and alcohol recovery center in Oklahoma City, providing the first steps toward achieving and maintaining sobriety. Their dedicated staff is experienced in residential treatment, individual and group therapy, intensive outpatient treatment, and detoxification.
