Ken Clowes recalls years ago relapsing shortly after he was advised by a court judge to get off medication for opioid use disorder.

The community initiatives center assistant at Butler County Community College, Clowes said the judge’s advice was “completely counterintuitive,” noting that there had been no maliciousness behind the decision, but that a lack of education around addiction and recovery was evident.

“In another county many years ago, I had a DUI, and there were a couple substances in my system,” Clowes said. “One of them was a medication I was using properly. When I went to court, the judge told me I needed to get off the medication to treat my opioid disorder.

“Nothing was said about the medication I was actually abusing.”

From misunderstandings around how it treats withdrawal symptoms to the social stigma that surrounds it, medication for opioid use disorder — also known as medication-assisted treatment — seems shrouded in misconceptions.

One misconception, in particular, assumes that someone is not sober if taking prescribed medication for withdrawal, which experts say can put pressure on people to abruptly stop, and can lead to relapse.

Misconceptions about recovery, which are sometimes expressed from within the recovery community itself, can make it hard for people trying to stay sober to rebuild their lives, Clowes said.

When provided at the appropriate dose, these medications have no adverse effects on mental capability or physical functioning, Dr. C. Thomas Brophy, medical director of the Ellen O’Brien Gaiser Center, said at the center’s second annual Discover Recovery event in January.

According to the Substance Abuse and Mental Health Services Administration, a branch of the federal Department of Health and Human Services, medications that relieve withdrawal symptoms and physiological cravings, in combination with other therapies, include methadone, Sublocade, Suboxone and Vivitrol.

Donna Jenereski, director of the county Drug and Alcohol Program, called these medications “lifesaving” for some, and emphasized they should be used in conjunction with ongoing counseling and therapeutic support.

Both Clowes and Jenereski said that one common misnomer about medication for opioid use disorder is that it substitutes one addiction for another.

Within the recovery community, Clowes said, people who take medication may be stigmatized more than those who don’t take medication.

“A lot of people are reclaiming their lives … while on medication (for opioid use disorder) whether they have the ambition to get off it in the near future or not,” he said. “Being in recovery means continuing to move forward in your life.”

According to its policy manual, the Butler County Court of Common Pleas’ Drug Treatment Court allows medication for opioid use disorder within the program “on a case-by-case basis once a competent physician with expertise in addiction deems a product medically necessary.”

The policy was changed after Butler County was identified by the Justice Department as one of six counties in Pennsylvania to have had “problematic policies that prohibit or otherwise limit the use of (opioid use disorder) medication by individuals under court supervision.”

“The Butler County Court of Common Pleas’ Drug Treatment Court, until June 2021, stated in its publicly-available policy manual that it did not allow the use of methadone or Suboxone while in the program,” the letter wrote.

Adam Kummer, a probation officer with the Butler County Drug Treatment Court program, stated Butler now has multiple locations “for service providers that utilize MAT (Medication Assisted Treatment) and work with the Drug Treatment Court participants in obtaining the treatment and medications that are needed.”

“The Butler County Drug Treatment Court does permit the use of Medication Assisted Treatment and has witnessed many successful outcomes when combining the appropriate treatment and the appropriate MAT,” Kummer stated. “ … Butler is fortunate in this regard for having numerous provider options for those in need.”

Nevertheless, stigma around medication for opioid use disorder persists.

“Sometimes individuals that use medications are told they’re not sober in recovery, which is really unfortunate because so many people try to white knuckle it through, and that can lead to an overdose death,” addiction specialist Rachel Shuster said. “These medications, specifically buprenorphine — which is also known as Suboxone — or methadone, can decrease the risk of overdose by over 50%.”

She said she has heard from people whose sponsors in recovery told them would not work with them if they used medications.

“They were told, ‘I’m not going to work the 12 steps with you until you are completely clean,’” Shuster said. “And so then they’re not allowed to start doing the internal work that really matters.”

Jenereski said stigma surrounding medication for opioid use disorder persists in the recovery community itself.

“Many people take many different pathways (to recovery), and we're at a point now where we need to accept that,” she said. “Just because somebody's journey includes medication assisted treatment, and another's doesn't, that doesn't necessarily mean that one is wrong and one is right.”

Stigma is “one of those things that just has a way of, of growing and just seeping into everything,” said Donna Jenereski, director of the county Drug and Alcohol Program.

“When (stigma is) present in the community, when it's present within the health care world, people feel that, and who wants to go and ask for help when they're made to feel like they're less than or worthless?” Jenereski said. “Stigma impacts the community. You know, people begin to believe people who use substances are not good or they are bad due to a moral failing.”

The stigma, propelled by ignorance, embeds itself into how people talk and write about addiction, Shuster said, and has real-world implications on the quality of patient care and public perception.

In a Harvard study conducted in 2010, 600 doctorate-level clinicians were given example descriptions of patients with a history of drug use.

The clinicians were found to favor punishment, rather than treatment, for individuals described as being “substance abusers” rather than having “substance use disorder.”

The study was replicated with the general population.

“A patient described as an addict versus a patient with an opioid use disorder, they get treated differently because of personal biases,” Shuster said.

She said stigmatizing language around recovery persists because addiction is “seen as something that you choose.”

“There’s certainly an element of choice when someone uses drugs, but I guarantee most people — even without problematic substance use history — have used drugs,” she said. “We’re all rolling the dice. Every time we take a sip of alcohol, it’s rolling the dice.”

“It’s always a gamble,” she said. “A lot of use substances that are more or less stigmatized, and it’s even bizarre, like a pill is less stigmatized than someone who’s using a needle.”

In Butler County, Shuster said she wants to see the number of overdose deaths plummet to zero.

“If we still have overdose deaths, we’re not doing enough,” Shuster said.

“Every single person deserves life,” she said. “We’re all afforded that, and we all deserve to live. No one should be written off as an undesirable and someone who just ‘deserves to die.’”