So Your Family Wants You off Medication Treatment for Opioid Use Disorder… Now What?
What to do if your methadone or buprenorphine are helping you recover, but the lack of support from loved ones isn’t.
First: congratulations. Methadone and buprenorphine are the gold standard of treatment for OUD, but making the decision to begin treatment in the first place is tough. It’s even tougher to go through 12-72 hours of abstinence usually required to start on these medications without risking overdose or precipitated withdrawal. Then, continuing to show up and commit to recovery is one more tough, courageous choice. If, on top of everything, you are doing that without your family’s support, you deserve major props. You’re awesome.
Now, how to deal with those family members who are insisting that you get off the meds that are helping you get your life back together. First, try to understand that your family is most likely saying this out of love. It’s misguided for sure, but they probably have your best interests at heart.
Medication Stigma Is Rampant
If your friends or family are telling you to get off methadone or buprenorphine, they likely share one or several stigma-fueled misconceptions about these medicines. Ideas like that you are just trading one addiction for another, or that these medicines are just supposed to be short-term detox aids. They might think you’re getting high on your methadone, or just getting your buprenorphine to trade on the street for your drug of choice. Knowing that they think this way might make it easier to empathize with them. After all, if you thought someone you loved was taking medication that caused these kinds of problems, you’d probably want them off of it too. But that doesn’t mean you have to stand for it.
Educating your family is a great step toward helping resolve some of the issues that are keeping them from being supportive of your recovery. There are great resources online that discuss the efficacy of methadone and buprenorphine. These include statements from the World Health Organization, the U.S. Department of Health and Human Services, and a number of detailed articles and studies by a variety of addiction experts. To summarize these findings: because methadone and buprenorphine are opioid-based medications, they will cause you to have a continued dependency on opiates. But dependency describes a physical habituation to a substance, and addiction is a psychological state marked by compulsive use despite negative consequences. When used as prescribed, methadone and buprenorphine treat addiction; they don’t cause it. So you’re not trading one addiction for another. You’re continuing to have a physical dependency—similar to someone who takes insulin or antidepressants—but you’re getting rid of the addiction. They also won’t get you high if you have an established opioid tolerance and use them as directed. And while diversion is sometimes a problem, the fact is that these drugs are also harm reduction tools that prevent fatal overdose. So if someone were to take buprenorphine and still sometimes use heroin, he’d still be a lot safer than if he didn’t have access to buprenorphine at all.
Seek Out Peer Support
People can be stubborn, especially when it comes to longstanding beliefs. If you’ve given your family all the facts and they still tell you to get off your medication, it’s time to look for outside support. This is really important because humans are social creatures and naturally susceptible to influence. Sometimes, even when you know something to be true, if you keep hearing its opposite, you might start to change your mind without realizing it. But if these medicines work for you, it’s important to stick with them. Peer support can help you hold to your convictions, and will also introduce you to others who are going through experiences similar to yours.
Depending on where you live, peer support might be hard to find in person. Many people in addiction recovery turn to 12-step groups for peer support. 12-step groups are available for free almost anywhere, but this can be tricky for some methadone and buprenorphine patients. While each meeting governs itself independently, there is a strongly held belief in many (especially Narcotics Anonymous) that these medicines do not constitute true sobriety. Some meetings are moving away from this belief, and some opioid treatment providers have even begun incorporating medication-specific 12-step meetings into their programs, but if one of these is not near you (or if you object to 12-step groups for other reasons), you will need to find a different route. SMART recovery is a nonreligious option that is more accepting of medication recovery models, but in-person groups are less available than 12-step meetings. In the online community, Facebook has several medication specific recovery groups. Some of these are geared only to methadone patients, some to buprenorphine patients, some to mothers on methadone, and some to anyone on OUD medication. A word of warning: general recovery groups that are not geared toward medication patients may also include people who disparage these medicines. Unfortunately, this stigma pervades even the wider recovery community.
Take Care of Yourself
It’s enormously hard to do something that is inherently difficult without the support of your loved ones. If you’re having to engage in medication-based addiction treatment while your family tells you what you’re doing is wrong, you’re overcoming more than many will understand. Take care of yourself. Be gentle with yourself. If you have a slip or relapse, don’t beat yourself up. The only thing you can do is move forward. Try to remember to remind yourself every day that you’re not weak for taking medication (in fact, you’re strong), that you deserve health and happiness, and that you’re doing the right thing.