You can see me walking down the street,
right? And you're not gonna know that my
teeth aren't real, you're not gonna know
that I was just living on the street a
year ago, you're not gonna know that I'm
in medically assisted treatment. I look
like a normal person because that's what
people in treatment look like, we're
everyone else. We hear a lot about
America's opioid epidemic, and that today
the number one cause of death of all
people under the age of 50 is drug
overdoses—that's past car crashes and
heart disease. You know, we often think, "Oh,
that could never happen to me, right?" And
yet it affects every area of the U.S. And
a big part of the solution begets with
us and the way we, as a society, perceive
and treat addiction.
Heroin's such a bad thing, right? But
these people that I'm really close with,
they're doing it, so it must be OK. You
think that everything's OK at first,
which is like the worst part about it, it's
like you don't expect what happens to
happen. One of the biggest misconceptions
about people who are addicted to opioids
and who are trying to get off is just
this idea that they can just get clean,
they can just kind of shake it off, and
then they'll be fine, and they can go
live the rest of their life. And while
that may be true for a tiny number of
people, what actually happens is a vast
majority of them, upwards of 90 percent, are
going to end up relapsing. When I
was eight months pregnant, when I was eight
months pregnant and I would, like, still
wasn't able to get clean, and I didn't want
to lose my baby. And like, it makes me
like, really emotional right now to talk
about that because like of everything
that I've gone through with him, right
now just to keep him, so just thinking about
like, if I didn't get the help that I
needed, like, I wouldn't be here right now
with him.
Despite a number of attempts to get
clean, Andrea was on heroin for six years,
along with meth for two of them. This is
a chronic illness. It's like with
diabetes, you know, we don't say that, "OK,
so you've got a week, and you got to get
rid of all the sugar, and make your
diabetes go away." No, with diabetes we
expect they're gonna have this for the
rest of their lives, and we need to treat
them. At no point do we say, "You've messed
up, you've had your last piece of white
toast, we're gonna take away all of your
medications, we're gonna take away all
your treatment, we're gonna abandon you
as a patient or as a member of society."
We don't do that, of course not. They have
a chronic disease and we need to treat
them. Effective treatment doesn't just
mean kicking it off, but actually getting
treatment, which involves typically
medications and behavioral therapy.
Medication assisted treatment is not a
new thing. You've probably heard of
methadone clinics. Well, methadone is one
of the three medications used in MAT.
It's worth noting, though, that methadone
is not the street drug meth or
methamphetamines. So the idea is that
instead of having someone just stop
using or go cold turkey, they're treated
with medication, sometimes indefinitely,
along with therapy. This approach is how
Andrea got off heroin through a program
called Project Nurture. We have our own little
niche as part of the opioid crisis.
That's partly run by Dr. Livingston's
colleague, Dr. Amanda Risser for pregnant
women with opioid use disorder. We're so
busy.
Assuming that only about 10 percent of
people who could benefit from these
medications are getting access to them,
you know,. While no treatment for any
medical issue is perfect, these
medications will really help people.
Medication assisted treatment has been
embraced by the CDC, the NIH, the FDA,
SAMHSA, the World Health Organization, and
the list goes on. And it's viewed by most
healthcare providers as the most
effective way to treat addiction. So
what's the holdup in making this the
norm? Stigma. There's talk about it not
being authentic recovery or trading one
addiction for another.
This is inaccurate and it really harms
people. When I met Dr. Risser, she's just
like, "Hey, what can we do?" You know, that
was really cool to experience that
because that's not normal. And that's why
I think a lot of women that are pregnant
that are using don't get help because
they don't think that there's a doctor
out there like that. And Project Nurture
breaks that stigma about like, you know,
being, being pregnant and using and like
thinking that you're just screwed.
You have to realize that addiction is
this incredibly strong process that
changes your brain chemistry. It's
something that you actually need
intensive treatment for in order to
overcome. And to overcome the present we
need to understand the past. Around the
turn of the century, there was a huge
amount of attention paid on pain. And
some of that emerged because it was an
important issue and some of it was kind
of fostered by drug companies that had a
financial interest in folks treating
pain aggressively. Physicians really were
given the message that these medications
are not only safe, but also what we
should be doing in order to be doing
good care. The effects were not really
understood completely until the last
five or so years, so as people maybe
developed dependence on these medications,
for many people it actually became
cost-effective to turn to things like
heroin. We, as a medical community, were
manipulated into providing treatments
to folks that hurt them—and that is
something that I think we're not talking
a lot about, and how we feel complicit in
the opiate crisis. That's kind of the
saddest part to me about all of this is
that there's been this huge epidemic
that's caused death and destruction in a
lot of people's lives and we weren't
even successfully treating the thing
that we tried to in the first place,
which was pain. When Oregon, in between
2015 and 2016, the state produced some
data that showed that we've had a death
rate going down. Part of it is making
sure that people have access to opioid
use disorder treatments, and
making sure that we have naloxone readily
available. And a huge contributor has
been the fact that we're just
prescribing less opioids. We need to
change what we think of the right
treatment of pain is because a lot of pain
is best managed by things you can
actually do on your own, and that might
be increasing exercise, mind-body therapy,
those sorts of things may be more
effective than any pill that can be
prescribed by a physician. But the goal
whenever we are approaching somebody who
has an addiction problem is first to
realize that they are a person, a human
being, and not an addict. We've had our
patients blow our expectations out of
the water, over and over again. We're not
really doing anything all that special,
except for just being there. I'm going to
school. I am like, I'm a great mom to my
son. That might sound conceited but like,
I know I'm a great mom and that's
because Project Nurture, because I've
had support, and it's because I'm sober.
You keep going, huh? Yeah, so crazy, a year
ago like, I was sleeping in a car. You
know, you have to retrain yourself to
deal with your feelings because when
you're using, you're literally taking
your feelings and suffocating them. The
goal is to teach him enough coping skills
about like self-acceptance and stuff
that eventually, if he does come across
the situation where he's offered, he
doesn't feel like he needs to.
And the next thing for me and what my
choice would be is to be a radiologist,
so that means going to medical school
and getting my specialty in radiology. I
know it's gonna be tough, and I know it's
gonna be hard to manage my homework and
being a good mom, and all that stuff, but
I've shown myself like, you can go from
nothing to something so quick, and why
stop there?