Editor’s Note: Marvin Seppala deserves high praise for what he has done regarding the use of buprenorphine. Like many other clinicians, he evaluated the clinical evidence regarding the effectiveness of buprenorphine and began to offer his opioid addicted patients the option of remaining on the medication beyond withdrawal management to facilitate their recovery. What is different about Marv is that – as the chief medical officer of the oldest traditional, abstinence and 12-Step based residential treatment programs – he has been subjected to particularly intense criticism for doing this and has nevertheless persevered. I believe that his patients and their loved ones will be the beneficiaries of his courage.
Two years ago when Dr. Marvin Seppala spoke at the National Association of Addiction Treatment Providers annual meeting about incorporating the use of buprenorphine and extended release naltrexone to treat opioid use disorders, he didn’t get much support. This wasn’t the case when he spoke at the NAATP meeting earlier this year. As treatment professionals become more aware of the opioid use disorder crisis in this country, they are increasingly open to trying new methods of treatment.
Hazelden first introduced anti-addiction medications in 2012. While Dr. Marvin Seppala acknowledges that this was a significant cultural and organizational shift, he believes it was one that was necessary and critical to addressing the growing problem of opioid use disorders. He talked with Modern Addiction Recovery about the effects of incorporating buprenorphine and extended release naltrexone into treatment programs.
Modern Addiction Recovery: What was the impetus for your incorporating buprenorphine into your treatment programs?
Seppala: It started with the recognition of the national crisis – the tremendous increase in opioid overdose deaths and admissions for opioid use disorders. We had people leaving treatment for opioid dependence without completing it.
They were leaving early, and we started having behavioral problems in our residential programs. Patients were working together to get drugs into treatment rather than bonding around getting treatment. We realized that we were inadequately providing care for this population. Since incorporating our new program, with additional group therapy for opioid use disorders, and use of buprenorphine and extended release naltrexone into treatment in our residential opioid dependence program, we went form 25 percent of patients leaving early down to 5 percent.
MAR: What surprised you the most about the clinical response, both negative and positive?
Seppala: The most surprising was how much support we received from our counseling staff. We thought they would resist the change. We changed a lot of things, and we thought our counselors wouldn’t like the use of medications, especially buprenorphine. .
We did training forums at our locations around the country, and part way through the first presentation a counselor asked, “How many have had a patient die from opioid overdose after treatment?” It’s common enough that 75 percent of our counselors have had this experience. Recognizing why we were making the changes was so essential, and then they could relate our strategy to their own experience and see the possibility that this approach could work better for some folks. We learned that communication was so important. Telling staff members the why and allowing people to engage in conversations through forums rather than just lecturing them was crucial.
MAR: What surprised you about the community’s response, both positive and negative?
Seppala: We had both ends of the spectrum. There was outrage from medical addiction colleagues who felt we had forsaken our original purpose. Some in Alcoholics Anonymous said we were ruining AA. On the other hand, we had people congratulating us on taking this step.
In general, abstinence-based programs wanted nothing to do with it, and I understand their views because there is the potential for abuse of buprenorphine. However, these medications are proven effective and can provide better outcomes.
And our patients on medications attend NA and AA meetings. We know that they may face resistance and ridicule, but we’ve been able to find meetings for them that don’t follow the recommendations of the national groups and are accepting of people on medication.
MAR: Why was this decision important? Do you see it as part of a growing trend?
Seppala: It’s been important for our organization because the crisis is real, and we have to do everything we can to address overdose deaths from opioid dependence. We need to use addiction science as the foundation for our clinical decision-making. We built our treatment programs based on fact.
From an external perspective, because of our reputation, the fact that we would go down this path has the ability to influence other programs and help them make changes. I feel really good about that. But we couldn’t have done by ourselves. We got a lot help from others.
Hopefully more people in the addictions field will look at medications as a viable part of treatment and not be pushed away by bias or their own clinical perspectives. My hope would be that we get the word out and people will work actively to address this problem.
We thank Marvin Seppala for his insights. To learn more about addiction treatment, contact us.