It was quarter to seven, and St. Mark’s Church in Frankford, Philadelphia, was home to your typical pre-meeting bustle: A woman in pink in her mid-40s dragged mismatched metal chairs across the floor into a circle while the sound of a coffeepot crackled behind her. As is often the case in 12-step groups, there were concerns over the coffee—was it too light? (it was), would there be enough for next week’s meeting? (there wouldn’t). Family Dollar was allegedly out of sugar.
This wasn’t an Alcoholics Anonymous or a Narcotics Anonymous meeting, though. This was a Medication-Assisted Recovery Anonymous, or a MARA meeting, a gathering of people who were united by their desire to recover from their addictions, but who also recognized that the best way for them to do this might involve anti-craving medications like methadone and buprenorphine, known by the brand name Suboxone.
It was a light turnout that night—about 25 people—according to a woman holding a cane sitting next to me. All but two in the group were female. One member shared a story of working up the nerve to tell her AA sponsor that she’s on 45 mg of methadone, something that is too often discouraged in the AA model. When she shared, the compassion was audible; this kind of concern is all too common.
In the midst of America’s deadliest addiction epidemic—a crisis in which the national life expectancy has fallen for the second consecutive year due to opioid overdoses’ impact—there is still an enormous and problematic stigma within 12-step groups against members who take prescribed medications to manage their addictions. Though at the organizational level, groups like AA and NA consider medication an “outside issue,” at the local group level, it is subtly, and sometimes explicitly, discouraged. Members who do not take these medications often marginalize those who do by excluding them from meeting participation, turning them down when they ask for sponsorship, and telling them that they’re not actually in recovery.
The use of prescribed methadone and buprenorphine—referred to as medication-assisted recovery when combined with psychosocial treatments like peer support and talk therapy—is undeniably the most effective treatment for opioid use disorder, according to the evidence. Research has repeatedly shown that these medications reduce opioid addiction–related deaths by 50 percent or more, increase treatment retention, and decrease infectious disease transmission and criminal activity.
Despite this evidence, patients with opioid use disorder frequently receive pressure from family members, 12-step groups, and outdated, punitive policies in treatment centers, recovery houses, and court systems to not take these medications at all, or to stop taking them before they’re ready, according to addiction specialists who treat them. Dr. Sarah Wakeman, the medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital, attributes much of this stigma to confusion between physiological dependence and addiction.
Physiological dependence, Wakeman explains, means that if an individual stops taking a drug or medication, they’ll get sick, just like a person with diabetes gets sick without insulin. Addiction, on the other hand, is defined as compulsively using substances despite harmful consequences. Medications like methadone and buprenorphine are prescribed to assist with physiological dependence, which prevents them from getting sick so they can focus on their recovery. Individuals on the proper dose of these medications who take them as prescribed can lead full, high-functioning lives both socially and professionally.
But AA and NA are programs based upon total abstinence from mind- or mood-altering substances, and many members consider addiction and dependence synonymous. In 2016, NA published a pamphlet called Narcotics Anonymous and Persons Receiving Medication-Assisted Treatment, in which it states, “By definition, medically assisted therapy indicates that medication is being given to people to treat addiction. In NA, addiction is treated by abstinence and through application of the spiritual principles contained in the Twelve Steps of Narcotics Anonymous.” So while some members and groups (due to the organization’s autonomous structure) are open-minded to individuals on medication, many others have interpreted this to mean that if a person takes methadone or buprenorphine, he may as well be using heroin.
“I think it’s heartbreaking because if a person had cancer or had any other chronic illness and they were valiantly managing it, people in their lives would be supporting them and encouraging them to take their medication every day to stay healthy,” Wakeman tells me. “The need to keep it a secret or feel like it’s something shameful when people are doing really well on treatment is challenging and can really undermine someone’s recovery.”
Megan McAllister knows that feeling of shame all too well. While attending other 12-step meetings, she’s witnessed people stop clapping and whisper when someone on methadone announced their recovery anniversary. Some members have even gossiped to her about others who take the very same medication she’s taking because they don’t realize she’s taking it.
“Why should I feel ashamed for doing something that’s saved my life?” McAllister asks me. “I was putting a needle in my arm every 10 minutes—methadone saved my life.”
She started taking the medication after unsuccessful attempts to treat her heroin addiction with buprenorphine. Since starting the medication, McAllister has gone to work every day and takes care of her 3- and 9-year-old children. Perhaps most impressive, she inherited a support group for individuals in recovery on medication from a local certified recovery specialist named Freddie Laboy and almost immediately formed MARA, which she plans to expand to offer meetings on different days and in different neighborhoods across the city.
Now MARA has group conscience meetings the second Wednesday each month; service positions including a chairperson, coffee person, secretary, treasurer, and researcher; an official format; and its own literature. Word seems to be getting around, as MARA was recently contacted by someone who wants to start a new group on the other side of the country in Abilene, Texas. For a few months now, Justin Uphill, a peer recovery coach at the Abilene Regional Council on Alcohol and Drug Abuse, has been talking with another recovery coach and one of the local doctors about starting a MARA group at their facility.
At 7:01 in Frankford, Megan McAllister knocked on her chair to quiet the room for the start of the meeting. The chairperson was running late, so she gave a quick welcome, held a moment of silence, and asked a volunteer to read the preamble, which was now typed and no longer written by hand, as it was just a month or so earlier.
“We, of Medication-Assisted Recovery Anonymous,” she read, “believe that medication is a therapeutic tool of recovery that may or may not be discontinued in time, dependent upon the needs of the individual.”