The woman on the phone said the house was perfect. It had recovery help, her kids could visit, even sleep over, and she could keep her phone.
Then came the pivotal question: “Are you on MAT?” the New Foundations Transitional Living representative asked, referring to medication-assisted treatment.
“She said, ‘Yes, Suboxone.'”
Mikella Chrisman politely told the woman that she could not move in.
“She started crying,” said Chrisman, executive director of New Foundations, in Mount Auburn. “She had called so many other places and everyone told her the same, exact thing: ‘We cannot take you if you’re on medication-assisted treatment.'”
“It broke my heart,” Chrisman said. “That is when I decided that we had to do better.”
So New Foundations, which already allowed people on non-narcotic Vivitrol in its Cincinnati and Northern Kentucky homes, changed. It got safety upgrades, trained its managers and instituted a new policy accepting people who take any FDA-approved medication for opioid addiction.
In an era where heroin, fentanyl and prescription pain-pill addiction are at epidemic levels, a lot of people who’ve made their way into recovery are in best-practices, medication-assisted treatment.
And just when they hit recovery, they are left without housing that experts say can be essential to their success. Because traditional sober-living houses, places where people in recovery come together to live with mutual support, often don’t accept people in MAT, as it’s commonly called.
Just ask advocates who try to find housing for people in recovery.
Terry Smith, a founder of OneCity Against Heroin, a Warren County-based group that helps people with opioid addiction, said she gets turned down regularly when she tries to find sober living for people in MAT.
“There’s no sadder thing than to tell a loved one that we have no place for them to go,” Smith said.
It’s also illegal.
The U.S. Substance Abuse and Mental Health Administration tells medication-assisted treatment patients in a “Know Your Rights” brochure that, like anyone else with addiction, they’re disabled under the Americans with Disabilities Act, and the Fair Housing Act applies to them, too.
“Individuals who live or want to live in halfway houses, recovery homes, or other residences for individuals in recovery are sometimes excluded because of their participation in MAT,” the brochure states. “This is illegal even though this type of discrimination occurs with some frequency.”
Kentucky public health makes it clear: “Lack of access to housing which supports the use of life-saving, evidence-based medications is discrimination,” said Beth Fisher, spokeswoman for the Cabinet for Health and Family Services.
David Sheridan, founder of the National Alliance for Recovery Residences, in California, which offers certification for these houses, said his agency tells recovery-housing operators the same, again and again.
“You can’t systematically exclude someone who is taking legitimate medication for a disorder.”
Sheridan said he understands why it’s been a problem.
Traditionally, a lot of people “did cold-turkey detox” to get off alcohol and other drugs. Those who stayed sober were welcomed into sober-living homes, he said. “It was a different culture.”
The houses are not treatment centers, Sheridan said, so part of the argument has been, why take people in treatment? And the government cannot make them take on exorbitant costs to accommodate residents.
Beyond all that, there’s the ultimate issue of concern: Abstinence.
Sober means abstaining from drugs and alcohol, Sheridan said. Abstinence is the rule at sober-living houses, and to some, that flies in the face of using opioids – such as methadone and buprenorphine – in recovery.
There’s a common idea that these drugs are just substitutes for illegal ones.
The best treatment for heroin addiction is a combination of medication and therapy. Terry DeMio/The Enquirer
But addiction experts say that’s not so. The anti-addiction medications normalize brain chemistry, block the euphoric effects of opioids, relieve cravings and stabilize body functions.
As for the treatment part? Drug addiction by definition is a chronic, relapsing disorder. So continuing treatment is necessary, specialists say.
The National Alliance for Recovery Residences is trying to address the problem by asking recovery-house operators to redefine abstinence: Include those who take medication if it’s FDA-approved for their addiction.
That doesn’t mean self-medicating. Those who smoke marijuana, for example, or use medical marijuana prescribed for another ailment, are not abstinent – because they’re taking an alternative drug, Sheridan said.
“Our recommendation is, let’s not stigmatize these people anymore. They’re already being stigmatized,” Sheridan said. “Let’s embrace them.”
In March, the alliance released a guide on how to do it.
New Foundations follows that guide.
House manager Roxanna Kendrick said the switch in April to offering housing to people in MAT has been simple.
She does not take medication for her recovery, but the East Price Hill house that she manages has women residents who do.
“The people are not different than anyone else,” Kendrick said.
The regimen is to give each woman a lockable bag and key. They put their medication in the bags. The bags go into a lockable safe. The safe is in a lockable kitchen cabinet. There’s a security camera in the kitchen pointing in the direction of the cabinet.
Each morning, Kendrick calls each woman into the kitchen, one at a time, unlocks the cabinet and the safe and hands her a locked bag with her name. The woman uses her own key to unlock the bag and pulls out her medication. She lines up the melt-away tablets two by two on the counter and she and Kendrick count them. She takes what she’s supposed to take and puts the rest back into the bottle, then into the locked bag. Kendrick logs the medication-take for each woman, then checks their mouths to make sure the pills have dissolved.
“To me, it’s just a medication that they need,” she said.
Ashleigh O’Neill, 25, says the housing is life-saving.
“I need this. We all help hold each other up. We’re like sisters here,” she said.
“I am sure I’d have been abusing myself if I was on my own.”
The emerging trend in sober-living homes is to do as New Foundations did: modify rules to welcome people taking medication, say recovery housing experts in Ohio.
In the Cincinnati area, Talbert House and First Step Home also are among recovery houses that accept residents who are in medication-assisted treatment.
Ohio makes the inclusion of people in this treatment more alluring by offering money and other assistance to house operators who welcome them.
“We were having trouble finding enough providers who would allow persons on medication-assisted treatment,” said Ellen Augspurger, project director for Ohio’s share of federal funding for opioid response.
So the state found 77 recovery housing operators in Ohio and sent them notice that they could get free lockboxes for residents’ medication. More than 40% signed up.
The state also has made $6 million available, through September, to partner with addiction and mental health boards on housing for people in recovery from opioid addiction and their families. To qualify, the housing can’t make residents taper from or stop FDA-approved medications for their addiction.
Ohio is ahead of a lot of states, Sheridan said, with its Ohio Recovery Housing.
The nonprofit encourages housing operators to get certified to or beyond standards of the National Alliance for Recovery Residences, said Executive Director Danielle Gray. The standards are straightforward, such as: uphold residents’ rights, provide recovery programming to residents and promote health.
Certification is voluntary, Sheridan said, because of the Fair Housing Act.
“A state can’t require a group of disabled people who live together to have a license,” Sheridan said.
Likewise, he said, “They can’t shut down bad operators directly.”
“The current system is a mess,” said Fred Muench, president of the Center on Addiction in New York City, a science-based, nonpartisan nonprofit that researches and promotes policy to end the U.S. addiction crisis.
“We need more quality options that offer things like case management and MAT support,” Muench said.
The good news, say Sheridan and Gray, is that certification is becoming more common.
From April 2018 through May this year, Ohio Recovery Housing saw a 10% increase in homes certified, Gray said. There are currently 85 organizations that operate 159 certified homes in the state.
Neighboring Kentucky is making recovery housing for those in MAT a priority, too.
The Kentucky Opioid Response Effort is working to increase the number of “high-quality recovery residences that support access to all forms of FDA-approved medications with federal funding,” Fisher said. The effort will provide 10 one-year grants to increase by 150 the number of recovery residence slots that support those in MAT.
New Foundations’ goal is to be certified by Ohio Recovery Housing in 2020.
Along with that goal, Chrisman announced in May several changes to align the housing to national and state standards.
These are among the changes:
O’Neill’s search for recovery housing went on for four days. She, her mother, the treatment center she was leaving and a nonprofit advocate made call after call, only to be turned down repeatedly because she was on medication.
Then someone gave O’Neill the word: New Foundations would accept her.