Death for Drug Dealers, or Hope for Addicted People?

The Trump administration’s increasingly contradictory stance on the opioid epidemic could leave many without options

Rachel Mabe


Illustrations by Jessica Siao

Ali Boast, a nurse at Magee’s Pregnancy Recovery Center (PRC), sits behind the wheel of a red Kia Sportage and sips from her coffee mug. It’s 7:00 a.m. on a Friday, and she’s left her home in Pittsburgh to drive north an hour to Butler, an old manufacturing town. Boast occasionally passes lines of bare trees, but primarily the scenery of these 35 miles is a suburban sprawl alternating between car dealerships and strip malls. Her final destination, a rural outreach center, is in one of these strip malls.

The PRC was one of the first clinics to use a whole-person team-based model for opioid-dependent pregnant women. This means the center addresses all parts of a patient’s care under one roof by providing medication-assisted treatment (specifically using buprenorphine), counseling, access to a peer navigator (who has experience in recovery), group sessions, prenatal care, delivery, and assistance with issues like housing and transportation.

When most people think of medication for opioid addiction, they think of methadone, which is a full agonist, meaning it allows a morphine-like response. Buprenorphine, on the other hand, is a partial agonist — it blocks some of the opioid receptors, providing a partial opioid response. This means that most patients report a decrease in cravings — perhaps more energy, but not a real high. Also important, the doctors prescribing the buprenorphine are obstetricians, working in tandem with the counselors, nurses, and peer navigators, which results in more comprehensive care.

When the PRC applied for a Center of Excellence grant through the state of Pennsylvania, one of the key components was not only expanding its central Pittsburgh clinic, but also its outreach to rural communities. In the past year, the PRC opened five rural centers. It picked communities without easy access to Pittsburgh and with high overdose rates. Assuming women would flock to the centers, Boast is surprised that Butler is its biggest clinic, with just four consistent patients.