On-Site MAT Program May Be in Above and Beyond’s Future

Pharmacist reaching for medication

Being a source of support for the homeless and at-need population in Chicago, Above and Beyond Family Recovery Center has always been on the lookout for programs it can add to its already impressive line of care. Housing, job, and domestic violence referrals by nature are often primary or secondary issues that are learned upon initial intake assessments for substance use treatment clients.

“We are looking to be a one-stop-shop of sorts,” said Alicia Gattis, intake specialist, art therapist, and lead counselor. “We even have a notary on site.” 

If something is not offered by them, they have developed contacts with other programs to refer to and vice versa. One area is the addition of a medication-assisted treatment (MAT) program. Forty-four of Above and Beyond’s 215 patients, or 20%, were being treated for opioid use disorder as of February.

This possible addition takes some time to examine because of the medical licensing aspect involved with on-site medication regulations.

What Is MAT?

Medication-assisted therapy involves prescription opioid blockers like methadone or Suboxone® to ease symptoms from substance withdrawal and decrease the chance for relapse. 

The response to each medication varies with the individual, and one person may do better with one or the other.

Methadone (oral suspension liquid) is a medication administered to patients at a clinic in a daily dose. As their need lessens and their response to psychotherapy improves, they may receive more doses to take on their own. This is a typically less expensive program.

Suboxone (mostly moved from dissolving tablets, to dissolving sublingual strips on the tongue) is administered through a similar protocol at a clinic first, eventually moving to self-administration, and can be approved through insurance. 

Calming the withdrawal symptoms is incredibly important because until the cravings subside, it is nearly impossible to focus on seeing beyond the next few hours, let alone imagining a path forward — away from something that has consumed their daily focus. With a rise in heroin use and a subsequent increase in overdose deaths, having a proven tool to fight this dependence is sorely needed.

As one person described his experience with his first dose of Suboxone, in just minutes he felt relief. 

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Opioid inhibitors are medically recognized as effective for chronic users of opioids and have many benefits, according to the National Institute on Drug Abuse:

Abundant evidence shows that methadone, buprenorphine, and naltrexone all reduce opioid use and opioid use disorder-related symptoms, and they reduce the risk of infectious disease transmission as well as criminal behavior associated with drug use. These medications also increase the likelihood that a person will remain in treatment, which itself is associated with lower risk of overdose mortality, reduced risk of HIV and HCV transmission, reduced criminal justice involvement, and greater likelihood of employment.

This relief is not a “high,” as some mistakenly believe, or simply replacing one addiction with another. Prescriptions are often not administered unless there is well-documented proof of therapy in conjunction with MAT. The ultimate goal is to help someone be able to participate in further treatment while potentially weaning off MAT, which can take months or even years.

It is one part of a multi-faceted approach not limited to, but including

  • Psychotherapy to better understand where the patient is in their addiction and to learn coping strategies to change behaviors that have formed during use
  • Substance support groups to increase their contact with other people committed to the same goals.
  • Life skills to help people build their future through methods such as opening a checking account, getting personal references as their reliability improves, learning how to apply for jobs
  • Housing assistance to get off the street and away from influences that keep them exposed to substances

Javier’s Story: How MAT Therapy Helped Kick Heroin

Stephen and Javier

Javier Rodriguez is one of the many people at Above and Beyond Recovery Center who helps clients who are trying to put their lives together and recover from addiction. He knows from first-hand experience what heroin dependence can do to an individual.

After 16 years in Illinois state prisons stemming from six arrests and convictions, Javier knew one thing. 

He didn’t want to ever step foot in prison again.

Though he was born in Puerto Rico, Javier has lived in Chicago for 42 years. His first marriage lasted five years, but his ex-wife divorced him after his first three-year prison sentence. They had a son and a daughter together, now grown. 

He smoked some weed, drank alcohol, and used a little cocaine as a teen, but his heroin introduction came at age 16 when a school friend brought it to school. 

“At that point in time, whatever you put in front of me I would try, and so I did (heroin). It was a pretty rough experience for me. I got sick and ended up passing out on the bus. It was cool and different. I always remembered it and didn’t go back to it.”

“When I did, it was by accident. My father was terminally ill, and he was taking medications and I used to steal them. I had some of his morphine pills and I didn’t know I would become addicted. The nurse took the medicine while he was in hospice care. I realized I was withdrawing and sick and didn’t know why. I described it and my friend said I’m dope sick. I said I don’t do those things and then put it together.”

“I started using heroin and thought ‘Oh wow, this is great.’ I was a heavy smoker and drinker and that stopped. All I did was heroin and everything else went to the side, and it became my dealing with the trauma of his death to numb my pain.”

This began his pattern of stealing to support his habit which led to six prison terms of several years each. During this time, his wife divorced him, and he lost contact with his children, his sister, and his mother.

They cut me off because my life was being ruined. I didn’t care, but I really did care, I just didn’t want to feel bad. I was raised in Chicago street gang culture and the first time (in prison) was a rite of passage. I was a seasoned vet and the people in the penitentiary knew me. But I never quite reached the level of desensitization.”
You are not alone

Javier says while he was sober behind locked prison doors, out on the street he returned to his old behaviors. His in/out cycle stopped when he was alone in a motel, scared to use anymore because he felt his body wouldn’t survive much longer. 

“It was May 18, 2018. I was in a seedy crack motel by myself and I felt like I was OD-ing and my life was slipping away. I couldn’t breathe. Obviously, I didn’t because I didn’t go unconscious, but I felt if I did any more my body would shut down and couldn’t take anymore.”

Javier, now 48, is a healthy 192 pounds today, but at that time carried only 129 pounds on his 5-foot-10-inch frame.

“My mom was scared and my sister was scared. We were crying to each other and emotional. She’s (sister) a nurse at a clinic, and they have the medication-assisted treatment (MAT) plan. I tried methadone and 28-day programs. This was my last shot. I didn’t have anywhere else to go and ran out of options. I didn’t want to go through illness and withdrawals — it’s terrible.”

Javier was given Suboxone at Mile Square Health Center.

“I dosed and it (withdrawal symptoms) went away in minutes.”

He says he relapsed a few times in the next few months but overcame that because he didn’t want to steal anymore and the effort was no longer worth the reward of a high. He was ready to make the move to transitional sober housing, but at first balked at the requirement to enroll in a partial outpatient program (POP). He was referred to Above and Beyond Family Recovery Center.

“I came in kicking and screaming. I didn’t want a POP. But I started picking up things that worked for other people and started seeing how they would work for me.

“I’m kind of homegrown,” he said of his time with Above and Beyond. “I came in as a client, did the work, and am now an employee.

He still receives MAT, but his initial daily dosage of 16 milligrams is now down to 0.5, and he no longer has to visit the clinic for a daily dose. He has proven his commitment to working his program, and now his medication is managed a month or two at a time through a telehealth virtual appointment.

He sounds seemingly amazed at how far he has come. And he has come far from that seedy crack motel wondering how he could get help from his struggle with heroin. After two-and-a-half years with Above and Beyond, Javier is now a certified recovery support specialist, leads seven groups weekly, and acts as a peer mentor for substance use disorders and co-occurring mental health conditions. He refers to himself as “a middle-man advocate liaison.

When he’s not working, he enjoys his family relationships that have been restored and spends time with his children and grandchildren. He has his own apartment and is working on saving up to begin the process of getting his driver’s license back someday.

Misconceptions Miss Point of MAT Program

The biggest misconception comes from our deeply ingrained belief from 12-step culture if you take anything you're not sober. For people in a MAT program, this belief misses the point of addiction,” said Stephen Kotsiris, 33, Senior Counselor and Director of First Impressions at Above and Beyond.

“We define the clinical diagnosis for addiction as it interferes with your ability to function. It impacts your psycho-social behaviors such as the ability to regulate emotions, forming relationships, effective communication, and participating in structure as necessary for work or school. We use therapy to revisit behavior with more healthy coping strategies in someone’s life who is struggling in these areas.”

Stephen emphasizes these treatment efforts often cannot effectively begin for someone with chronic opioid use, and they must first manage their physical symptoms through a MAT program. 

“It’s the difference between addiction and dependence. If they have to take it (MAT) and are able to do the rest, no disorder is present. It is no different than waking up and taking blood pressure medication or anything else, like a mood stabilizer for a bipolar condition.”

“When someone is using methadone or Suboxone as prescribed and using a program to engage, to reconnect with life, they’re no longer addicted.”

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Area Programs Pool Resources 

MAT Teamwork

Javier found Above and Beyond because his sober living home required outpatient treatment. This is not uncommon because many agencies realize MAT is not a solution to opioid recovery alone, Stephen said. Therapy is also a requirement by many prescribers and states. 

Realizing this symbiotic nature, Chicago substance use treatment providers have developed relationships with each other, often informally, to refer patients to various programs depending on need. For example, if a patient walks in the door to Above and Beyond and during their intake assessment share they are seeking help with heroin or methamphetamine, one question might be to find out if they are currently receiving MAT treatment or if they need a referral to a program.

Counselors like Stephen know they can reach out to Eddie Sanchez. Sanchez, 58, is an outreach counselor and recovery coach at Roseland Community Hospital. Like Javier, he was addicted to opioids and other substances and has been in recovery for 15 years. For the past 11 years, he has helped people with substance use disorders and knows the ins and outs of many centers in the city. Who has room? Which place is closer? 

“Eddie’ll know,” Stephen sums it up.

Eddie concurs, saying “I find the place. If I don’t find the place, nobody has room in Chicago.”

In turn, Eddie was very happy to see Above and Beyond open its doors nearly six years ago in an area being underserved. While he can find MAT treatment, finding free outpatient therapy can be difficult. He said he has referred about 20 people to Above and Beyond, and it has referred about 25 to him.

He emphasized a referral from him doesn’t come unless he has thoroughly vetted an organization.

“The counselors and people seem to really care,” Eddie said. “I need to see the environment and engage with the counselors and the staff to see if it’s going to benefit my patients. I couldn’t find a place to have a successful recovery. There was nobody to help me coming up from my addiction. It’s dear to me. My goal is to have a nice place for my patients.”

Other agencies Above and Beyond is linked to include Thorek Memorial Hospital’s “New Vision” program and GreenBax Health Solutions. Thorek recommends Above and Beyond to patients upon discharge for continuity of care. GreenBax is a newer medical provider on the city’s west side and can assist with MAT programs. Currently, they have nursing students attend group sessions to learn more about substance use disorders as part of their education.

On-site MAT Clinic Being Studied

According to Alicia Gattis, the need for MAT programs is not a question and goes hand-in-hand with Above and Beyond’s harm reduction philosophy. Above and Beyond began to seriously consider it in spring 2020 and hopes to see one open in the next year-and-a-half. The undertaking of operating a MAT clinic, however, must be fully explored on many levels, with input from Medical Director Dr. Fran Langdon.

Key considerations:

  • Being able to meet the expected demand for MAT, while ensuring counseling services are maintained at their superior level 
  • Obtaining necessary state licensing
  • Consideration of a partnership to operate the on-site clinic
  • Funding for operating costs
  • Creating clinic space

Eddie Sanchez said a MAT program would greatly benefit the neighborhood.

“It would be nice if they could incorporate a clinic because they’ll have everything in-house. It's a great place and I like to send people there. It’s a struggle and to recover, you have to change.”

Alicia echoes his desire hopefully but balances it with caution.

We want to treat as many people as possible without breaking, literally, at the seams.” 

Above and Beyond Hopes To Grow in Sixth Year

Above and Beyond opened its doors over five years ago to serve Chicago’s homeless and disadvantaged on the city’s west side with its free outpatient addiction treatment. It has come to be a growing magnet of resources for the community, with strong donor and volunteer support to help with its programs. Its high standards extend to staff, several of whom are program alumni who felt moved to pay their recovery forward. To learn more about MAT programs, addiction outpatient services, volunteer efforts, or donor support, contact Above and Beyond Family Recovery Services at 773-940-2960.

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