She delivered the last statement with defiance, as if trying to convince someone.

When N.A. member Amber suggests to people on MAT that they get off of their medicine, she does so politely. She has talked to people like the women from MATTR, and advised them against maintenance drugs: “I would encourage you to get off of Suboxone,” she said, reminding them that it can be bought off the streets and used to get high. Amber, who has also asked to be identified by her first name, had tried Suboxone herself, but said she felt that her doctors pressured her into taking it. They would tell her that if she just took this medication, she would not need to get high anymore. To Amber, however, it felt like “substituting one drug for another,” as she said. Today, she is one of many N.A. and A.A. members who have a clear stance on MAT: “You don’t need to be on Suboxone.”

But to many addicts on MAT, like David and Michael, this approach feels like cruel and needless banishment. With the help of methadone, Michael has been sober since last summer. David, after years of relapses and recovery, recently chose to quit A.A. and find a support group open to everyone—including people on MAT. Today, he has been sober for over a year. Still, last fall he decided to wean off medication again. Prescriptions and visits to the doctor cost him almost the same as rent. But that was not the only reason. The negative opinions toward MAT among his peers in A.A. continued to bother him: “Coming from this absolutist black-and-white recovery community, where you had to be totally abstinent and off of everything, I still had pressure in my own mind to get off MAT.”

The hunt for complete abstinence still haunts many of the people they know—or have known. “If five years ago there was no stigma attached to MAT and if it was accessible and affordable, I think a lot of our friends would probably still be alive,” Michael said in January in a Starbucks on the outskirts of Louisville.

“How many people have died that we were friends with?” he asked David, who was calmly sipping a bottle of orange juice.

Both of them looked distant. Losing a friend had long ceased being an extraordinary event.

“Jesse, Mike, Muff.”

They counted on their fingers, but ran out of fingers to count.

“Burford, Kyle.”

“Who’d you say?”

“Noodle.”

“Oh, yeah. Noodle.”

“And Devon?”

“And then the people I know from A.A. It’s an even larger number,” David said.

“Jon.”

“Yeah, and Erica, she died that same day,” David said quietly. He was the one who talked her into going to A.A., where she eventually decided to stop taking methadone. She relapsed and died.

He shrugged. “I lose count. I think it’s at least 30. And at least 15 of my close, close friends.”

“I mean really, it’s just me and you and two other friends from our old group that are still alive,” Michael said.

If everybody needs a tribe, most of theirs is gone.