Why we’re saying F*ck Rehab

Rehab (n): A set of myths about treatment for (opioid) addiction.

Before we can have this conversation, we need to reckon with a f*cked up status quo:

• Opioid overdose is the #1 cause of death for Americans under 50. [1]
• The only proven treatment for opioid addiction is Medication-Assisted Treatment (MAT). [2]
• Fewer than 20% of Americans with opioid addiction get any form of treatment. [3]
• Fewer than half of all rehab programs offer any form of MAT. [4]

Clearly, we need big, bold, and immediate change, and that’s the intent of this campaign. To understand what and how and why, let’s first define our terms.

What is MAT? 

MAT is a chronic treatment for opioid addiction that includes FDA-approved medications and counseling. It looks like the treatment for anxiety or depression that millions of us get today with minimal disruption to our lives. MAT is not only the “standard of care” for opioid addiction: it’s the only treatment proven to work at all. And it works extremely well, reducing mortality by more than half (and reducing healthcare costs by thousands per patient). Put simply, if everyone who needed MAT could get it, far fewer people would die every day, the “opioid crisis” would reverse its course, and we'd all spend less on healthcare.

What is “rehab”?

Rehab is a construct that represents how society thinks about addiction treatment. If you want to stop using opioids, the common narrative goes, you need to "go to rehab.” Rehab might mean months away from your family at a sober living home. It might mean weekly drug tests and in-person support groups when you’re supposed to be at work. It might mean a short-term detox with no long-term plan when you get out. In short, “rehab” is what you get when you strip away MAT, the essential core of evidence-based treatment for opioid addiction. For most programs, there’s no MAT in the first place. For others, it’s bundled with a set of difficult requirements that add barriers and cost but little clinical value (but are how programs get paid by insurers). The perception that these requirements are the treatment itself is the fundamental myth of rehab. 

Ophelia’s F*ck Rehab campaign

The myth of rehab is the target of our campaign. As long as people believe this myth – that “it’s rehab or nothing” – most will choose nothing, and most who choose something will get the wrong thing. We must dispel this myth and replace it with the truth, which turns out to be far happier: opioid addiction is treatable, the treatment is easier than you think, and it might actually be what you want. Every day, thousands of people spend thousands of dollars for MAT medications on the black market, instead of getting medical treatment covered by insurance! If we wish to prevent these people from dying, we need to make it easier to choose clinicians than drug dealers – which means not hiding these clinicians behind the barriers of rehab.

What happens if you offer MAT without rehab? As providers like Ophelia are proving today, if you provide only what works, in the way people want it, you get better access, better outcomes, better satisfaction, and lower costs. In fact, virtually all telehealth-based MAT providers are showing patient retention that is 2x or higher than in-person rehab programs: as we know from decades of peer-reviewed research, high retention means high success, from survival to long-term health and happiness.

We’re saying f*ck rehab because we know it will save lives. This message must be delivered, and cursing has proven to be an effective way to deliver it. We know that it will anger some people, and we know that this will create risk for us at Ophelia. But no one is angrier than we are today – and every 7 minutes another American will die until someone has the courage to scream the f*cking truth.

Zack Gray (CEO, Ophelia)

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F*ck Rehab FAQs

Are you saying that Ophelia is the solution for everyone?

No. Ophelia is appropriate for most patients, but some require a higher level of medical care. We regularly refer to (and collaborate with) other medical providers, sometimes before initiating treatment and other times during the course of treatment.

Are you concerned about misleading patients?

We never say anything that we think could mislead patients, nor do we present Ophelia as more than just one option. We educate patients immediately about these options, beginning with the first FAQ on our website. At worst, patients end up with a free medical evaluation and a referral to a specialist who accepts their insurance.

Are you saying that people who work in rehabs are bad people?

Not at all. The rehab industry is full of people with good intentions. Some just don’t know the latest facts, many of which came to light after their programs were already in business. Others are doing their best but face regulatory constraints and insurance incentives that can make it hard to stay in business without enforcing strict program requirements. Regulators and insurers aren’t bad people either, but they’re slow to react to new data, and this creates problems for everyone.

Rehab worked for me, so doesn’t that invalidate your point?

No. It’s impossible to know what “works” without running controlled experiments. Even when a treatment has no efficacy at all (think “voodoo for cancer”), some people will be expected to survive, which means we can't then use those survivors as proof that the treatment worked, nor encourage them to open more voodoo clinics. In order to know what actually works, we need to look at controlled experiments in peer-reviewed journals. That’s the data that we use at Ophelia to make our decisions every day.

What about rehab for substances other than opioids?

Opioid use disorder is unlike other substance use disorders in important ways. For example, detox from alcohol or benzodiazepines can be deadly, so it should be done under in-person medical supervision. Furthermore, while MAT shows some effect in treating other disorders (such as alcohol use disorder), the effect size of the medications is smaller, so other treatment options (like abstinence-based treatment) are less dangerous. Ophelia is only making claims about opioid use disorder.

Why do you need to curse?

Our goal is to communicate a lifesaving message to everyone who might need to hear it. We’ve found that cursing is effective at getting this message to our audience, and that’s the entire purpose of the campaign. It also reflects how we honestly feel and the way we’d deliver the message to a friend. We curse in private because it works there too.

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