Christian drug rehabs debate the role of meds

Frank Schmitt experimented with party drugs and illicit pain pills in high school and college. Then he added heroin injections. “That didn’t last more than a year and a half before it took me down to my knees,” Schmitt said.

Desperate for relief from the cravings, Schmitt booked a telehealth appointment. The doctor prescribed him a 30-day supply of suboxone, an opioid replacement drug that gave him a similar euphoric feeling. Schmitt finished it within two weeks and filled the rest of the 30 days with heroin and other illicit opiates. Then he made another appointment and received his next prescription. The cycle lasted for about two years.

A few years and multiple treatment programs later, Schmitt got sober in 2016 thanks to therapy and accountability, not medication. He founded Heartwood Recovery in 2017, which operates a residential recovery program for men in Austin, Texas. Schmitt is still skeptical about using medication to treat opioid addiction. “It just prolongs the process for people,” he said.

Addiction medications have become the gold standard of care in many medical circles. Still, most private rehab facilities, especially faith-based programs, are wary of replacing drug addiction with dependence on medication. But that hesitation is slowly shifting as more Christian drug rehabs adopt the harm reduction approaches popular in secular addiction treatment.

Proponents of opioid abuse medications argue that the medications can mean the difference between life and death. Provisional data show overdose deaths in the United States once again topped 100,000 in 2022. Fentanyl-related drug overdoses are now the leading cause of death for Americans ages 18-49. Only 2 milligrams of the dangerous opioid can kill its users. Dealers often press fentanyl into pills that resemble prescription opioids or mix it into batches of heroin, methamphetamine, and cocaine.

Two types of medications can treat opioid addiction. Opioid agonists, sometimes called opioid replacements, stimulate the brain’s opiate receptors, though to a lesser degree than heroin or morphine. Patients go through withdrawal when they stop taking agonists such as methadone and buprenorphine, the generic term for medications like Suboxone, Buprenex, and Subutex.The second type, opioid antagonists, including naltrexone and naloxone, block the brain’s opiate receptors.

Dr. Warren Yamashita, a board-certified addiction physician in Santa Ana, Calif., often prescribes Suboxone to patients addicted to fentanyl. Over the past few years, he has seen more such patients, some of whom don’t even know they have the synthetic opioid in their system. Yamashita said opioid antagonist medications aren’t as effective when treating someone for fentanyl addiction, since the medications often require a person to be off the drug for a few weeks before taking them. Quitting fentanyl use is especially difficult because the drug lingers in a person’s fatty tissue and has “hijacked their brain,” he said.

Whether doctors should wean their patients off medications like Suboxone divides medical professionals, especially Christians, Yamashita said. He chairs the addiction medicine section of the Christian Medical and Dental Associations, which he said advocates for a “whole person perspective to treatment.”

For Yamashita, that means creating personalized treatment plans that include spiritual and relational assessments. He encourages his patients to get professional therapy and find social support. Some of his patients will taper off Suboxone, but others may need to take the drug the rest of their lives.

Dr. Annie Peters is the director of research and education at the National Association of Addiction Treatment Providers, an organization with over 900 members. Peters, who is also a clinical psychologist, has noticed a broader shift in treatment that focuses on first keeping someone alive so that he or she can enter long-term recovery. In some cases, state accreditation rules require treatment facilities to provide opioid abuse medication. Most publicly funded treatment programs have already adopted medication-assisted treatments, while private rehab organizations are shifting more slowly.

“Recovery happens in different ways,” Peters said. “And it really depends on the person and what they need.”

Dr. Eric Geisler, another CMDA member, told me the residential rehab program in Oregon where he previously served as medical director switched from an abstinence-only approach to using medications about three years ago. At about the same time, the state required drug and alcohol rehab facilities to offer the treatment as a condition of their license.

“What drove the decision were the results,” he told me earlier this year. After the program began using a long-acting, injectable version of Suboxone, about 80 percent of residents still participated in the program after six months. Before the switch, that number was only 10 to 20 percent.

But a large number of Christian rehab programs are sticking with an abstinence-based approach. Michael Hallett, a criminology and criminal justice professor at the University of North Florida, has studied the effects of faith-based programming on prisoner reentry into society after incarceration. He said small budgets and the volunteer-driven nature of many faith-based programs often mean that programs don’t have the resources to coordinate medical care for clients. More importantly, many abstinence-based programs believe that extended reliance on medications prevents clients from achieving full sobriety.

“Medication offers a false promise for dealing with a host of issues that are much broader than just the use of a substance,” said Hallett. He said that faith-based programs excel at helping clients address root causes like social isolation. Participants gain social capital and find acceptance by sharing their testimonies with others dealing with similar struggles.

Many of the Christian rehab programs I talked with shared Hallett’s concern that addiction medication is a replacement substance that hinders an addict’s long-term recovery. Tom Reynolds, the director of the residential rehab program, His Way, with campuses in Huntsville, Ala., and Atlanta, said the men in his program “have a vision for sobriety and being dependent on nothing.” The nonprofit was a finalist in WORLD’s Hope Awards for Effective Compassion in 2022. Reynolds said that the men who tried medically-assisted treatment before they arrived at His Way told him their doctors rarely encouraged them to wean off the medications.

That is part of the reason for Frank Schmitt’s skepticism. “It was originally used for short tapers, and then, you know, money came along, and people realized we can keep people on this forever,” he said. Heartwood Recovery isn’t explicitly Christian, but the men follow an abstinence-based 12-step program. Schmitt told me the program will allow medication use if a doctor prescribes it.

Some rehab programs are seeking a middle way. Bryan Braddock is president of House of Hope in Florence, S.C. The homeless ministry recently opened an addiction recovery center that prioritizes discipleship and therapy on a secluded, 140-acre camp. The staff does not require new clients to stop their medication regimen, but they also don’t encourage medication use.

Braddock is wary of switching out illicit drugs for a daily pill. Instead he urges men talking to a physician to stick to once-a-month injections of the opioid receptor blocker, Vivitrol—“something that will address that physical addiction, but doesn’t mimic the daily activities of addiction,” he said.

“We want to make sure that with any kind of medication, that we’re not setting someone up for failure,” Braddock said. “If you deny the spiritual side, someone isn’t going to get true victory.”