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Imagine you are struggling with an opioid addiction and trying to get your life together. When addicts get out of rehab, many of them rely on being able to live in recovery housing. In these group residences, people share meals. They look for jobs. They go to meetings. They do it all together in a community. Recovery houses require full sobriety, and for most of them that includes a ban on medication-assisted treatment like methadone or buprenorphine. That may be changing, though, as WHYY's Nina Feldman reports.
NINA FELDMAN, BYLINE: Cristina Rivell is 22, and she's been in and out of rehab for the past five years. The most recent time her doctor prescribed her a low-dose opioid called buprenorphine. Often known by its brand name, Suboxone, it curbs cravings and prevents withdrawal.
CRISTINA RIVELL: People think, like, that you feel something or you're, like, high. But when I take it, I just feel normal. I don't have my cravings.
FELDMAN: Rivell said she knew she needed to stick with medication-assisted treatment, or MAT, to get her life back together. And she knew she wanted to be in a recovery house where she would have a support group and be required to go to therapy.
RIVELL: When you're by yourself, it's easy to say to yourself, well, one day I'm just not going to take it and I'm going to get high for one day.
FELDMAN: So with her time in rehab running out, Rivell started calling around to see who would take her. But it wasn't looking good.
RIVELL: I would say right off the bat, like, I'm Cristina, I'm on Suboxone. I'm just looking for an open bed. And they're like, we don't take people on Suboxone and just hang up on me.
FELDMAN: Rivell was worried. She had nowhere else to go, and she was afraid she would become homeless. But eventually she found an unexpected ally.
BARB WILLIAMSON: Hi, welcome. I'm Barb Williamson.
FELDMAN: Barb Williamson opened her first recovery house in southeastern Pennsylvania in 2014. She was 25 and had been sober just a year herself. And back then, when people showed up on Suboxone or methadone and asked to live in her houses, she didn't even consider it.
WILLIAMSON: I just felt like I tried heroin when I was 15 years old, I quickly was doing it every single day. I ended up homeless in the streets. I was 98 pounds and willing to do anything for my next fix. And I just thought, if someone like me could get sober, why couldn't someone like you without medication?
FELDMAN: And then one day last November, Williamson was struck by a post from a community activist she knew on social media.
WILLIAMSON: A Facebook post about recovery houses not doing enough because we weren't welcoming people on MAT, which was making the people homeless and then using again. And, you know, she was pretty harsh and just saying we were a part of the problem.
FELDMAN: Williamson took the post really personally. So she set out to do some research and prove she was right. She took a couple trainings, talked to a lot of doctors, and she began to change her mind. Now Williamson runs four recovery houses for people on MAT. Cristina Rivell lives in one of them. But houses like these are still rare. The Pennsylvania Association for Recovery Residences estimates that out of the roughly 200 homes it certifies, about seven will take people on MAT. Nationally, less than half of all long-term residential facilities for opioid addiction allow maintenance medication.
There are a few reasons for that. A lot of recovery houses are closely aligned with 12-step programs, many of which count opioid-based treatment medications as breaking their abstinence-only rules. Jennell Botero also runs a recovery house. She doesn't let people on methadone or Suboxone live there and turns people away because of that all the time. She says she sees it is just replacing one drug with another.
JENNELL BOTERO: I have seen individuals who are on it who become dependent and don't taper off as they're supposed to but more stay on it for years and years.
FELDMAN: But the evidence shows these treatments reduce risks for relapse and overdose. Dr. Nora Volkow is head of the National Institute on Drug Abuse, the lead federal agency on addiction. She says that if we thought of addiction more as a disease, keeping people off treatment would seem crazy.
NORA VOLKOW: I don't see any other condition of disease where you basically ask the person, you have to forego the medication treatment if you want to leave here under these conditions.
FELDMAN: The tide is starting to change. Earlier this year, the city of Philadelphia began requiring that the small group of recovery houses it funds except people on MAT. The National Association of Recovery Residences is preparing a policy guide on how to offer treatment. After Williamson opened her first house, she wrote a message to the woman who got her thinking about all this in the first place.
WILLIAMSON: I introduced myself. I explained how I hated her guts and she consumed me.
FELDMAN: But now the two plan to work together on a training for other recovery house owners that debunks the myths about medication-assisted treatment. For NPR News, I'm Nina Feldman in Philadelphia.
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