America’s overdose crisis keeps changing shape.

In recent years, provisional CDC data have shown a sharp national decline in overdose deaths — even as public officials warn the street drug supply remains volatile and some communities see signs of a rebound.

That uncertainty is also reshaping the recovery world — especially around opioids. Some people find abstinence-based recovery works best. Others rely on medication-assisted treatment (MAT), using prescribed medicine like methadone or buprenorphine to stabilize a person and reduce the risk of relapse. But MAT has long divided the recovery community, fueling a stigma around a deceptively simple question:

When is someone sober?

In this encore episode of Us & Them, Trey Kay visits the Clarksburg Mission in Clarksburg, West Virginia — a Christian-centered recovery facility where people pursue different paths toward sobriety — and where debates about medication, morality and survival are never abstract.

This episode of Us & Them is presented with support from the Claude Worthington Benedum Foundation, the CRC Foundation and the West Virginia Humanities Council.

Subscribe to Us & Them on Apple Podcasts, NPR One, Spotify or wherever you get your podcasts, or listen to Us & Them on WVPB Radio.

Outside of a window. The window has words printed on it that read, "Clarksburg Mission." — A window at the **Clarksburg Mission** reflects a street scene outside the Christian-centered recovery facility in Clarksburg, W.Va. The mission supports residents pursuing abstinence-based recovery as well as medication-assisted treatment.

*Photo Credit: Trey Kay/West Virginia Public Broadcasting*

Outside a building on a mostly sunny day with a sign in the shape of a cross that reads "Jesus Saves." — A neon cross outside the Clarksburg Mission carries the message “Jesus Saves” at the Christian-centered recovery facility in Clarksburg, W.Va.

*Photo Credit: Trey Kay/West Virginia Public Broadcasting*

An middle aged man with gray hair and a trimmed gray beard and mustache sits in a chair and speaks to someone. He is wearing glasses, jeans, and a black zip-up hoodie. — **Lou Ortenzio**, then executive director of the Clarksburg Mission in Clarksburg, W.Va., speaks with Us & Them in 2021.

*Photo Credit: Trey Kay/West Virginia Public Broadcasting*

“It was magic. It was euphoria. It was incredible. It was energizing. I was 10 feet tall and bulletproof and it felt really good. I could just grab it and take it and no one would know. … It just continued and then it just progressed. And then it was an every night thing. And then slowly I had to have something to get out of bed in the morning because I felt so bad. … It is madness. I was crazed and it was all about pills. It was all about trying to feel better. I couldn't stop because if you stopped, you were sick. I mean, you'd vomit and have diarrhea and have chills and be anxious and stressed and all those other symptoms would come back.”

— Lou Ortenzio, former Clarksburg physician who lost his medical license after becoming addicted to opioid pain pills

Read the Atlantic feature “Physicians Get Addicted Too” for more on Lou Ortenzio’s journey from West Virginia doctor to opioid addiction and loss of his medical license, and his work in recovery.

A woman looks off camera somberly. She has black hair, sunglasses, and large hoop earrings. She wears a jean jacket and a tattoo is seen on her chest. — **Melissa Carter**, who was a recovery coach at the Clarksburg Mission in Clarksburg, W.Va., at the time of this 2021 reporting, shares her experience with recovery.

*Photo Credit: Trey Kay/West Virginia Public Broadcasting*

“I've just watched people get rejected because of what they're doing. And I know what that feels like and I know what they go through. And I'm the one that's got to scoop them back up, put them back on their feet and encourage them. … We're not supposed to push anybody out of a room. The most important person in the room is the newcomer. Whether they're using or not, that's what we're supposed to do, right. To keep them in the rooms, not push them out of the room. So if we're rejecting them or, you know, using all that stigma against them because of what they're doing, like we're pushing, we're pushing people away. People don't feel comfortable. … There really is something at stake here. … If you can't feel comfortable in your recovery and what you're doing, and know that you're doing the best you can and you're not using drugs, you're not sticking needles in your arms, you're not at risk of overdosing and dying and people support you through that, then what do you do? Because abstinence-based is not for everybody.”

— Melissa Carter

A middle aged woman smiles and looks toward the camera. Behind her is a sign that reads, "Clarksburg Mission, where love becomes..." and the rest of the sign is not shown. The woman is wearing a colorful dress shirt and earrings. Her hair is up in a bun. — **Angela Knight**, then program manager at the Clarksburg Mission in Clarksburg, W.Va., speaks with Us & Them in 2021.

*Photo Credit: Trey Kay/West Virginia Public Broadcasting*

“For the people that know that I'm on medicated assisted treatment, there is labels and I do get put down and shamed from certain members of the recovery community. … That I'm not really in recovery, I'm not clean. I'm substituting — my recovery doesn't count. I'm still using. … It made me question, am I really in recovery? Is what they're saying true? I felt shamed. And so then I felt ashamed of myself. … I wanted to run, to be perfectly honest. Luckily, I didn't. I continued going to meetings because I worked really hard to get in that seat and I want to be in recovery more than anything. So I stuck with it.”

— Angela Knight

Dr. James Berry, chair of behavioral medicine and psychiatry at West Virginia University’s Rockefeller Neuroscience Institute, speaks about medication-assisted treatment.

Photo courtesy of West Virginia University

“I've been steeped in this tension from day one when we first started using it [medication...