So, all of those things that Monique and Mike, you both been speaking to I think get
encompassed in that definition. And you know that complexity, I think unfortunately is not
the way that our systems are built. It's not the way that our healthcare providers are educated,
it's not the way that we finance the systems. And at the root of much of this is really stigma
and discrimination, I would say it's, you know, stigma is kind of the attitudes, then
discrimination is really that what people experience. And, you know, just to start, I have lots
of examples that I can cite, you know, in my work from my patients, my people that I have
been trying to help, but there's one that really sticks out, I think kind of that's relevant to this
conversation. And then we can talk more about, you know, how we really change things.
And that is, I had an opportunity that many years ago, I was the deputy health officer for a
local health department in Maryland. And we as the health department funded a long-term
recovery house, a long-term house and recovery program for people with substance use
disorders. And we also happened to run an opioid treatment program through the health
department. And so, we provided methadone, that was really kind of the medication at the
time that we had access to. And I had a young man in his twenties, late twenties, who had
been struggling with an opiate use disorder for about 10 years. He had been in and out of
residential treatment settings. Similar to your experience, Mike, he had been in drug court, he
had you know, been in and out of various different house of outpatient settings, intensive
outpatient. And every time he was not able to sustain the abstinence, I think that the treatment
programs and that all of his health professionals, that was what they told him he had to, he
had to get to.
He came to our opiate treatment program, very ambivalent about methadone. Not necessarily
sure that he really wanted to take this, his father you know, was very supportive of his
recovery journey, but also was not very sure about methadone. And but he started, cause he
said, you know, nothing else has worked. I got to do something different, and he actually
stabilized fairly quickly, but he really wanted more wraparound services, He wanted more
support. And so, the halfway house, the recovery house, that we funded, we thought, oh, he
would be a fair fantastic (INAUDIBLE) all of their criteria. So we referred him and he was
soundly rejected. And the reason for the rejection, they said, "No, you know, we just don't
take people on methadone.” And I remember calling the executive director and just, you
know, really saying, "Look, we fund you, we fund a third of your total annual operating
budget. Like this is not, this is discrimination." And he said, "Well, no, we just have a policy,
we don't pick people on methadone."
And I called our health officer, I called the state, we had a meeting with their executive
committee, we, you know, talked with them. With the head of the behavioral health
administration at the time where their funds originated. And the answer still was, "Nope, I
don't think we're going to take him." And eventually, the health officer and I met with their
board of directors, we did a big presentation on the disease of addiction. What happens in the
brain, medications, how they work, what the evidence is for reduction, significant-reductions
in mortality, morbidity, increases in quality of life. And one of the board members, I
distinctly remember said, "You know, we thought this way about antidepressants 25 years
ago, we really didn't like, we didn't take people on antidepressants 25 years ago, and now we
do. So, maybe we can change, maybe in 25 years, maybe we'll think differently about
methadone, but I doubt it." And they decided to reject the 90, the tens of thousands of dollars
that we were giving them. And they elected not to take it, rather than have to take patients on
people on methadone.