Suboxone: No stigma

The Martha’s Vineyard community remains locked in a struggle to reduce the prevalence of substance use disorder (SUD), which is for far too many Islanders a literal matter of life and death. Beginning with a broadly sponsored and supported forum last June, Island organizations and public agencies have rallied and shown an unusual willingness to collaborate and to share the heavy lifting, and the risks, of new programs to meet extraordinary needs.

Another important step in building awareness and public education occurred with a program focusing on destigmatizing addiction, held two weeks ago at the high school Performing Arts Center, and reported on by Barry Stringfellow (Feb. 9, “DPH head urges Islanders to rethink addiction assumptions”). Monica Bharel, a physician and commissioner of the Massachusetts Department of Public Health, made a loud and clear call to the 100 or so in attendance to see SUD as a medical disease; failing to erase the stigma attached to addiction means “it will be very difficult to bring down our opiate overdose death toll.”  

Given the importance of building and leveraging community awareness of treating SUD as a medical condition, the turnout for Dr. Bharel’s presentation offered a mixed message. It was heartening to see a good-size crowd, notably including newly elected State Representative Dylan Fernandes, whose support will be essential to keep state funding flowing.

A number of Island leaders joined Mr. Fernandes in the audience. But notably missing: According to the meeting’s sign-in sheets, not a single selectman — not one one from any Island town — managed to make the presentation. It’s incomprehensible that the towns don’t see this as an important part of their portfolios, that they can’t just outsource it and assume that their police and EMTs aren’t in the middle of it.

In addition to missing a meeting devoted to SUD destigmatization (and thereby contributing to it), they also missed an essential follow-on discussion. A complicated component of treatment possibilities for substance use disorder is the drug Suboxone (buprenorphine). In her remarks, Dr. Bharel attributed an approximately 50 percent reduction in the risk of death among overdose patients to methadone or Suboxone treatment. Dr. Bharel cited many years of peer review and national data in support of this treatment, but acknowledged that fewer than 5 percent of individuals presenting with nonfatal overdose actually receive it. The science behind Suboxone is solid, and clinical support from well-known programs nationally, such as Hazelden Betty Ford Foundation, is abundant.

Suboxone, which only succeeds as part of a rigorous treatment regimen, is available on the Island from three physicians, and soon through a new  program based at Martha’s Vineyard Community Services. These are in each case provided on an outpatient basis, and they are tremendously important programs in the Island’s fight against SUD and to destigmatize SUD patients.

But some significant number of patients need the support of a sober-living facility as well. We’re fortunate to have Vineyard House and its substantial resources and philanthropic base on the Island, and it’s the sole source of this service. The rub is that Vineyard House doesn’t admit residents taking Suboxone.

The Vineyard House board, which doesn’t count any physicians among its members, is concerned that Suboxone, itself an addictive drug, presents serious management challenges in a residential setting. But it’s effectiveness is clear, the clinical management challenges it poses will persist regardless of setting, and its unique ability to save lives can’t be ignored. As Dr. Charles Silberstein, a co-founder and former director of Vineyard House, has said in remarks shared with The Times for a story published this week (Barry Stringfellow, “National debate over Suboxone use is also a Vineyard debate”), “We know there are people for whom it doesn’t work, but for some people, it is amazing. There’s no question Suboxone saves lives. I see it every day. There are people who need to have their lives stabilized who would benefit from Vineyard House and Suboxone. Recovery also requires deeper work, therapy, intensive outpatient treatment, and working a program of sobriety. Vineyard House could provide that.”

Vineyard House is a private nonprofit organization and has a fiduciary responsibility to be thoughtful about the programs it sponsors. Like all community nonprofits, though, it also exists to meet community needs, and with a monopoly role in the community, it needs to give considerable weight to the extreme urgency SUD presents.

The Vineyard House board has expressed a willingness to continue consideration of the role of Suboxone in their residential setting. We urge them to follow the lead of Community Services and the Martha’s Vineyard Hospital, and the encouragement of the state Commissioner of Public Health, and find ways to integrate its residential setting into the growing web of Island services combating and destigmatizing substance use disorder.

For more background regarding SUD and Islander battles, see these stories: bit.ly/2MVOpiates and bit.ly/2LoveStory.