In 2002, the Federal Drug Administration (FDA) approved buprenorphine, a game-changing medication for many who are dependent on opioids. A combination of buprenorphine and naloxone, known under the brand name Suboxone, is used as an option for people who are dependent on opioids and express interest in medication-assisted recovery (MAR). However, starting Suboxone treatment is not easy, and it requires willpower and energy.
Brad Meck is a case manager in Prevention Point Philadelphia's Stabilization, Treatment and Engagement Program (STEP) who specifically supports people who want to treat their opioid addiction with Suboxone. He claimed that Prevention Point has around 250 participants in the MAR program. Adherence to the medication poses a challenge to many in recovery from opioid use disorder; however, speaking from personal experience Brad says it is the “most life-changing experience ever.”
"Brad was waiting for a treatment option from the minute he started using opioids."
Brad is very knowledgeable and passionate about Suboxone — his body language clearly expresses, “believe me, it works.” He himself is familiar with MAR, specifically Suboxone. He said, “I'm on Suboxone right now. Yes. It absolutely saved my life.” Brad was waiting for a treatment option from the minute he started using opioids. The approval of a life-saving medication felt like winning the lottery for him.
Nevertheless, Brad mentioned that the way into the treatment is not easy. “We are creatures of habit,” he said, alluding to the fact that drug use is more than just a medical dependency. Brad specifically noted that Suboxone only works for people who are dependent on opioids; people who are dependent on stimulants have to rely on other programs such as Medication Assisted Recovery Anonymous (MARA) or Narcotics Anonymous (NA).
The biggest burden for people who are using opioids who want to get on medication is the beginning stage of starting Suboxone treatment. A waiting period between the last use of opioids and the first dose of Suboxone is required. Brad said, “You have to wait long enough so that your receptors are clear of all opioids.”
The required withdrawal has been described by Brad as, “You have to be sick, very sick. So you have to wait at least 24 hours and probably a little more than that. You have to wait until you're pretty bad.”
Brad explained the “inhumane” feelings of withdrawal in the 24 to 36 hours of cold turkey, and that he makes sure his participants are in a safe space where they are able to get through a difficult time. Once the waiting period has passed and the receptors have been cleared, Brad explained, “you can try micro-dosing, taking an eighth of a strip (of Suboxone), maybe one milligram. And see if that works, if that doesn't make you sick, then you can take a whole strip.”*
Brad also mentioned that the longer a person uses Suboxone, the less likely they are to return to use. Equally, the longer a person had been using opioids in the past, the harder it will be for them to get on MAR.
"We want our Kensington neighbors to know that our programs, including STEP, are available for them too."
Prevention Point Philadelphia has eliminated one of the biggest burdens to accessing MAR, and that is access to health care. Suboxone is available to anyone who is interested in and eligible to enter the program, regardless of insurance status. Upon intake, everyone who does not currently have and is eligible for insurance is assisted with completing a medical insurance application. Anyone who wants to switch their insurance carrier is also assisted in doing so.
Prevention Point is not only offering services for unhoused people. Their goal is to reduce harm for all people who are using drugs —- all genders, races, and socioeconomic backgrounds. Hilary Disch, Communications Coordinator, added to the conversation that "we want our Kensington neighbors to know that all of our programs, including STEP, are available for them, too."
Brad encourages his participants to seriously consider MAR, specifically Suboxone. He said that his personal life experience helps him authentically advocate for the treatment. However, Brad also acknowledged the physical effect of withdrawal, and that he fully supports all of his participants along the way.
*Prevention Point Philadelphia recommends consulting your doctor for medical advice, including on MAR.
Photo by Kit Ramsey. Left to right: M Holliday-Davis, STEP Co-Coordinator; Dr. Serge-Emile Simpson, MOUD Provider; Max Atkinson, STEP Case Manager.