Dave Mountuori sipped on a coffee and leaned back in his chair at a doctor's office in New Haven. He's 26 years old, and he was there to get a drug that’s turning his life around.
"The Suboxone -- you take it. It doesn't make everything better, but it helps you feel okay to make your life better," Mountuori said.
Suboxone is a partial opioid. It's a combination of two drugs: buprenorphine and naloxone.
It's less widely known than methadone, but unlike that drug, it isn't acquired solely via regular trips to a clinic. For patients dealing with the highs and lows of addiction, doctors say Suboxone normalizes a patient, mitigates withdrawal symptoms, and in many ways, lets them get their life back.
For Mountuori, getting normalized was important. He started on opioids by taking a family member's painkillers. Eventually, he transitioned to heroin because the pills got too expensive. For about ten years, used heroin on and off. He wanted to stop using and feel better, but life was a constant ping-pong.
"You get clean. You get out. You ruin your life," Mountouri said. "You get a good job. You get a girlfriend, whatever. Everything feels good. Then you feel like you’ve made enough progress to get high again. And then that’s where you slip up. That’s happened at least five times for me."
"If you're spending your whole day trying to score heroin or get pain medications, you don't have time to think about establishing relationships with people. Looking for work. Job training," said Stephen Holt, co-director of the Addiction Recovery Clinic at Yale-New Haven Hospital.
Holt writes prescriptions for Suboxone, and said the drug can be one way to get patients out of that trap.
To explain how Suboxone works in the body, Holt said to picture a door.
"On one side of the door is where you are," he said. "And on the other side of the door is maybe euphoria, or pain relief."
But that door in your brain is locked. To go through, you need the right key.
"Sticking heroin or any opiate into the door like a key," he said. "You open the door, and you throw it open, and you go to the other side, where all those good feelings were."
In other words, take heroin, throw the door wide open -- and get a full high. But also run the risk of overdose and death.
But if you put Suboxone into that keyhole, Holt said it acts like a latch on the door, cracking it open, but only a bit.
"Suboxone opens the door … but it blocks you from actually going all the way to the other side," he said. "Moreover, it’s blocking the keyhole, so nothing else can go into the keyhole. You can’t put heroin into the keyhole anymore."
It's also true for other opioids, like Oxycontin or Percocet. Cravings can still be there, but Holt said the patient is much less likely to have an overdose.
"You'll have the positive feelings, but in a much smaller way -- in a partial way," he said.
With the opiate use disorder temporarily under control, Holt said Suboxone lets patients work on building family, friends, and a job back into their lives.
That’s where counseling comes in -- follow-up visits, therapy -- whatever is needed to support the patient and treat their illness like you would a chronic disease.
"Every time you see a patient who has an opiate user disorder, or an alcohol use disorder, or whatever it is, you just have to touch base and see how they’re doing," Holt said. "Even if it’s been six years since they last had a drink or used a pill ...you just have to ask them how they’re doing: [have] there been any temptations this week, or this month?"
For Dave Mountuori, Suboxone and that clinical maintenance are important.
"I've never actually tried it like I am now -- I'm actually committing to the program and working like I am supposed to," he said. "Before in my life, every day was just about getting high. I didn't really know how to stop."
Between Suboxone and coming to the clinic, Mountuori said he’s been doing pretty well. He’s working days as a landscaper, and at night he’s training as an HVAC technician. In other words, he’s getting his life back.
This is the second in WNPR's series of three stories on Connecticut's drug epidemic. Read the first story here, about why it's important to know which drugs caused a death. Read the third story as well, about the high cost of rehab.