For well over a decade, Jonathan Cline has struggled with opioid addiction. About two years ago, he started using the medication Suboxone to help him get clean. He didn’t follow a specific program with it and quickly began to use fentanyl while taking Suboxone, rationalizing it to himself because it did not involve needles.
On Dec. 28, Cline had been clean for 24 hours. After a third person offered him fentanyl, Cline was ready to succumb to temptation — but his dad showed up and Cline knew he could not.
“He was like, ‘You’ll never see me again if you do.’ And it wasn’t worth losing that relationship,” Cline said.
Later that night, a close family friend of Cline’s showed up at his trailer and told Cline he had an interview for him lined up at XChange Recovery. Though friends and family had been trying to convince Cline to go to XChange for years, hearing it this time was different.
“I have so much respect for that guy, he’s such a dear family friend. I just couldn’t tell him no,” Cline said.
By 9 p.m. that day, Cline was checked into the program and has been using methadone to stay sober ever since.
“I’ve overdosed 15 times, my dad has found me dead. I’ve been shocked back to life — I have a pacemaker in my heart,” Cline said. “I know that the one reason I’m still here is God’s not done with me yet.”
What happens to the brain on opioids
The human body has an opioid receptor system that works to modulate pain and rewards, according to Dr. Kevin Fischer, chief medical officer at Columbia River Mental Health Services. Bodies produce natural opioids, called endorphins. When opioid receptors are overstimulated, it creates euphoria. Synthetic opioids, such as fentanyl and heroin, create a greater sense of euphoria and disrupt the natural process.
The reward pathway in the brain runs on dopamine and has developed to reward behavior that increases the chance of survival. This area of the brain is filled with opioid receptors, making it extra sensitive to synthetic opioids, according to Dr. Todd Korthuis, head of addiction medicine and professor of medicine at OHSU.
“The problem is, drugs like heroin and fentanyl really high jack that process,” Korthuis said.
When synthetic opioids are introduced, they release so much dopamine that nothing else can compete. After the peak of the opioid effects, crashing blood levels often lead to withdrawal symptoms, according to Fischer.
Withdrawal symptoms vary but can be extremely painful. For Niles Haas, a house leader at XChange Recovery’s Heart Change House, fentanyl withdrawal symptoms were some of the worst moments of his life. Before committing to recovery, he would try to stay sober but use again just to avoid the pain. Now, Niles has been clean for almost a year, thanks in large part to medication-assisted treatment.
“We have got to meet people where they’re at. Just like people need medication for mental health, medication for diabetes, (medication-assisted treatment) is the same idea,” Haas said.
What is medication-assisted treatment?
Medications such as Suboxone, methadone and buprenorphine are commonly used to help treat synthetic opioid abuse. When used correctly, they can be extremely helpful at aiding in recovery.
However, the medications can be abused and as such, there are many misconceptions about the use of medication to treat addiction.
Steve Hogan spent many years addicted to heroin. During that time, he would often abuse Suboxone to help him “come down” from a high if he could not find more heroin. Without supervision and a holistic approach to treatment, the medication itself was easy to abuse. Now, Hogan has been using Suboxone, with oversight and in combination with other methods for recovery at XChange, for two and a half years. He has not used heroin in that time.
“A lot of folks take it on the streets to get high,” said Vicky Smith, co-founder and program director of XChange Recovery. “That’s where part of the stigma is.”
When medication-assisted treatment is used in combination with counseling and behavioral health therapies, it can be extremely effective, though just the medication on its own can work for some people as well, according to Fischer.
When prescribed Suboxone or methadone, the medication binds to the opioid receptors in the brain, slowly releasing over a period of time to create little euphoria, according to Fischer. The medications work to reduce cravings, prevent withdrawal symptoms and even block the effects of illicit opioids. Essentially, the medication helps the brain to feel normal to allow for the other work involved in recovery.
“Buprenorphine and methadone allow the brain to stabilize,” Korthuis said. “It’s not replacing one addiction with another — it’s treatment”
Medication-assisted treatment at XChange
After struggling to find success with Suboxone in the past, Cline was prescribed methadone by the NorthStar clinic at Columbia River Mental Health Services after checking in to XChange on Dec. 28. He is the first XChange client on methadone — all other clients of the program that are using medication-assisted treatment are on Suboxone.
“I have had tremendous success just in this last week,” Cline said. “I’m happy where I am. And I’m thankful to be here and I’m just gonna do it one day at a time.”
As ofTuesday, Cline has been sober for one week. Cline is living at XChange Recovery’s Heart Change House where he is working full time toward recovery. Not only is he getting prescription methadone from NorthStar, he is also getting behavioral therapy support and peer support with the other men he lives with that are also in recovery.
When on medication-assisted treatment while living at a house through XChange, the house manager helps monitor the medication intake. For Cline, this means he gets a ride to the NorthStar clinic three days a week where he takes his methadone. On the other four days, his house manager gives Cline his medication first thing in the morning.
“There is zero chance for abuse in this program,” Cline said. “We do not keep our medication, they are managed by staff. It is in a locked container in a locked room all day. It is dispensed at pretty much a set time. It is observed while being dispensed the whole time.”
For many people who struggle with addiction, having a structured approach to recovery, like that provided at NorthStar and XChange, is key. And for many, taking medication is what makes recovery possible.