In Rehab, ‘Two Warring Factions’: Abstinence vs. Medication

It’s true that if medications became the main form of addiction treatment, the pharmaceutical industry would benefit — an outrageous outcome, critics of the approach believe, given the industry’s role in creating the opioid epidemic. But medication-focused treatment would also threaten residential programs like JourneyPure, a for-profit company with locations in Florida and Kentucky as well as Tennessee. It charges an average of $15,000, and up to $26,000, for a monthlong stay, though many of its patients have private insurance that covers most of the cost.

Change started to come to the JourneyPure program here in Murfreesboro with the hiring of Mr. Perez as chief executive a year ago. He came from a treatment center in Memphis that has long used medication, and was struck by the resistance to it in Middle Tennessee, where even liberal Nashville still has just one methadone clinic.

A few months later, JourneyPure hired Dr. Stephen Loyd, who had been the medical director for the Tennessee Division of Substance Abuse Services. Dr. Loyd himself went through treatment for addiction to painkillers in 2004 and in his state role, became an evangelist for medication-assisted treatment.

Now he has a similar role as medical director for JourneyPure’s Middle Tennessee programs, where a few months ago he presented his bosses with a “manifesto” outlining how he wanted the company to use medications more aggressively, including by expanding its outpatient clinics and providing buprenorphine to more patients across its sites.

“You’ve got these two warring factions — the M.A.T. side and the abstinence-based side,” he said. “It’s almost like our national politics. Where’s the John McCain? Here, it’s going to be me.”

The medication that JourneyPure and other residential treatment programs use most is naltrexone, because it is not an opioid. It blocks the brain’s opioid receptors, preventing any high in patients who try to use opioids while on it. JourneyPure typically offers patients an initial shot near the end of their stay, with the option of returning monthly for more.

At Dr. Loyd’s urging, JourneyPure has also decided to let residential patients take buprenorphine, also known as Suboxone, if he recommends it. In the past, the company had used the medication only to help detoxing patients get through withdrawal.

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