Here’s the story: Youngster grows up in poverty, becomes addicted to opioids, gets in trouble with the law. Somehow manages to find his way into recovery with the help of buprenorphine. Now stable, he enrolls in college at age 32, gets his degree, completes law school. Passes the Tennessee bar exam, then spends the next three years of his life seeking a license to practice. The powers that be won’t permit it, unless and until he gets off the buprenorphine.

He disagrees. Why stop the medication that made all the difference for him? he reasons. He doesn’t want to give it up, and his doctors aren’t recommending it.

NBC News has the story:

Overcoming poverty and addiction, he passed the bar exam. Then his prescription got in the way.

Based on the evidence, you’d have to call this man a recovery success story. I’ve certainly known plenty of  patients who’ve used buprenorphine or methadone and still struggled to stay clean, and certainly never accomplished anywhere near as much in terms of life-altering change as this gentleman. I tend to give him the credit for his success, rather than the buprenorphine.

But if he feels he needs the medication to function normally, I see no reason for the rest of us to object. I mean, we don’t want to disincentivize someone’s recovery, do we?

It was apparent to me early on that it was going to be easier to get opioid disorder patients onto buprenorphine maintenance than it would be to get them off buprenorphine once they were stabilized. They were still opioid-dependent, after all, just on a much less harmful opioid. And hopefully, free from the self-destructive lifestyle of a street drug user.

But opioids do create dependence in many who use them.  Buprenorphine is an opioid, no different in that respect. Its harm reduction value was enough to justify its use. At the very least, it made a difference in terms of his likely survival. He hadn’t overdosed and died.

The ones who were able to eventually leave the medication behind for good were likely to be the exceptions. Perhaps one day that will change, but for now, we had to accept it.

In other parts of society, however, the attitude can be quite different. And so this man has run into the one barrier that he hasn’t been able to overcome, so far, at least — his chosen profession.