A few weeks ago, community members and physicians gathered for a town hall in Beckley, West Virginia. On the agenda? Whether a new psychiatric clinic downtown should be allowed to do medication-assisted treatment from their building.
“What matters is – it’s our neighborhood,” said community member Patty Teubert. “I don’t understand why you don’t hear that.”
Teubert was acting as the spokeswoman for others opposed to the facility, which seemed to be in the overwhelming majority in the meeting.
Back in January, two physicians who are brothers, Saad and Jawad Zafar, bought a vacant downtown building zoned commercial with the intention of expanding the older brother’s existing internal medicine clinic to include psychiatric services. Although zoned commercial and used as a medical practice previously, the building they bought is in a mixed-use neighborhood, which includes churches, homes and other medical practices.
“This is a medical and psychiatric clinic,” said younger brother Jawad Zafar, who is a psychiatrist. “Addiction is not our primary focus, but it is part of our treatment. Just like you would treat diabetes, we’re going to be treating addiction, because it falls under the realm of internal medicine and psychiatry together.”
But when the Beckley neighborhood found out the Zafars would be providing addiction treatment services from their new building, the neighborhood fought back.
“I’m not sure that there’s a good scenario the way it exists now – not in a neighborhood,” said Teubert.
Teubert said the community understands that addiction services are needed, but believes the neighborhood would be a much less safe place with the clinic there and that “those people,” meaning people struggling with addiction, should be treated away from homes.
But there’s little evidence to suggest that clinics providing medication-assisted treatment cause an increase in crime in the communities in which they are situated. In a statement to the local newspaper, The Register Herald, the Beckley Police Department said they haven’t observed increased crime around any of the MAT clinics in the city.
For the Zafars, that’s not a surprise. Crime usually occurs when people struggling with addiction are actively using drugs, not when they are in treatment, they said.
“Honestly, I was sick and tired of seeing grandparents have to raise the grandchildren because parents are suffering from addiction and the parents can’t seek treatment,” said Jawad Zafar.
Zafar said that as a psychiatrist who has specialized in addiction treatment, he could have gone anywhere in the country with his skills, and been paid a lot more than he will make in Beckley. But West Virginia is home and the most desperate need is here. So he stayed.
“That was my rationale to come back. And now I’m questioning – actually after this [referring to vocal, active signs of opposition] – I’m questioning whether this was the right decision for me to make,” he said.
Teubert said it’s not the addiction treatment that bothers the community, it’s the medication-assisted part. She said there is disagreement within the medical community about how long people should be be on a medication-assisted program, with some programs weaning patients off the medication in a certain period of time and others allowing them to stay on it indefinitely. The concern, she said, is that people in the program will sell their medication, and the community will see an increase in drug deals or needles on the street and in parks.
The proposed Beckley facility is modeled after one in Morgantown at West Virginia University. For people in this model program, the notion that this kind of treatment center generates crime is ludicrous.
“It’s regular drugs that cause crime. You know Suboxone is a medicine, it’s not really a drug that you get high off. It keeps a person from getting on drugs,” said Cassie, whose last name is being omitted to protect her privacy.
Cassie is part of a long-term recovery group in the WVU Comprehensive Opioid Addiction Treatment program. She and four other women, including Megan from whom you’re about to hear, told their stories about addiction and recovery.
“I didn’t want to be on anything assisted, I just wanted to do cold turkey, and honestly being put on Suboxone and the whole program – everything about it – all the group therapy, all the therapy individual therapy, all the requirements, are really what kept me clean and built a really strong recovery for me,” said Megan. “I have 464 days clean and still doing good.”
For them, medication-assisted treatment saved their lives. It allowed them to get jobs, be parents to their children, and re-enter society as productive members. Every major medical association in the United States – from the National Institutes of Health to the federal Substance Abuse and Mental Health Services Administration – recognizes medication-assisted treatment, combined with therapy, as an effective treatment for opioid-use disorders.
A 2015 Harvard review of studies found that when patients are prescribed medication in their addiction treatment, the rate they stay sober doubles, in comparison to patients who are prescribed no medication or given a placebo.
But personal perception and science don’t always correlate. Teubert and her neighbors have seen their community shift dramatically under the weight of the opioid crisis. She points to an incident where somebody was found shooting up in her workplace bathroom as evidence of the potential impact on the community.
“I used to leave my door unlocked,” Teubert said. “I don’t leave my door unlocked anymore.”
Many at the town hall seem to view addiction, or at least the actions that led to addiction, as a choice – one the community should not be made to suffer from. They also fault physicians for overprescribing opioids. The “not in our neighborhood” response from the Beckley community is not dissimilar from other examples around the state where people have tried to establish sober living homes.
Zafars and patients in recovery view matters differently. They see addiction as a disease, and believe the paths to developing that disease are as many and varied as the paths to diabetes and nicotine addiction.
“What would be the next? Are they going to tell us that we can’t treat HIV patients? We can’t treat hepatitis patients? Because it’s going to bring their property values down?” said older brother Saad Zafar.
For the Zafars, the concept of “not in my neighborhood” is ridiculous because addiction is already in almost all neighborhoods in West Virginia.
But Teubert said no matter how the building was zoned when the Zafars bought it, the neighborhood will fight to get the zoning changed so the physicians can’t prescribe Suboxone from that facility. So far the community has put together a petition to bar medication assisted treatment in residential neighborhoods. The Beckley city attorney has said he will review whether such a request could be legally implemented.
The Zafars said they wouldn’t have bought the building in the first place if it hadn’t been zoned the way it was. And until the zoning is changed, they’ll continue giving their patients the best care they can, including treating those who are addicted using protocols that are currently standard..
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.
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