Highpower

Highpower is a rural Suboxone clinic in Lebanon, Virginia, founded by addiction specialist Hughes Melton in 2000 to treat people with limited access to care. Run with his wife, pharmacy professor Sarah Melton, it joined medication-assisted treatment to screening and counseling. The clinic occupies a consequential place in the book’s portrait of treatment: it was a model for expanding care, a source of firsthand evidence about buprenorphine diversion, and part of a wider debate over how to provide effective medication without ignoring misuse or barriers to access.

Identity and Origins

Hughes Melton established Highpower in 2000 because he wanted to treat underserved patients. The book presents the practice as a rural counterpart to the work of Art Van Zee, and later as an example used in Virginia’s effort to widen medication-assisted treatment. Its location in Lebanon placed it within a region where patients faced limited treatment capacity and where the availability and use of buprenorphine were subjects of public controversy.

Highpower was a family-run practice. Sarah Melton, a pharmacy professor and statewide patient advocate, helped her husband operate the clinic. She also trained health professionals on opioid risks and took action against doctors she believed were overprescribing. The couple’s clinical work and public advocacy connected the daily provision of treatment to a larger debate over prescribing standards and state policy.

Treatment and Clinic Practice

Highpower treated patients with Suboxone, a buprenorphine medication that also contains naloxone. The clinic required urine screening and provided both group and individual counseling. These practices distinguished its approach from accounts in the book of clinics where medication was prescribed in ways that patients said facilitated diversion, and from cash-only treatment arrangements that made continuing care costly.

Sarah Melton described Suboxone as a valuable medicine, while emphasizing that the clinic had encountered deaths involving people injecting high doses of Subutex, a buprenorphine formulation without naloxone. She attributed that danger, in part, to physicians seeking excessive profits. The distinction mattered: buprenorphine treatment could help reduce withdrawal and cravings, but formulations and prescribing practices shaped the risks patients faced. Highpower’s screening and counseling requirements represented an effort to provide medication within a more closely monitored treatment setting.

The clinic also became a place where patients explained how buprenorphine moved outside its intended treatment use. Several patients first described diversion and abuse to the book’s author at Highpower. These accounts challenged the assumption, voiced by some harm-reduction proponents elsewhere, that such misuse was too uncommon to warrant attention. The book treats the reports as evidence of a real implementation problem, not as proof that medication treatment itself was ineffective.

Role in Virginia’s Treatment Response

By 2017, Hughes Melton was helping direct Virginia’s response to the opioid crisis. He made a weekly round trip in his own airplane between Highpower and his office in Richmond, reflecting the demands of simultaneously running a rural clinic and advising the state. His initiatives included expanding medication-assisted treatment, advancing syringe exchange, and tightening controls on prescribing.

Melton also worked with Virginia Medicaid officials to broaden reimbursement for treatment and include payment for required counseling and care coordination. Those changes were intended partly to encourage cash-only clinics to accept insurance, including Medicaid. The book does not establish that Highpower itself adopted every policy or payment change; it identifies Melton’s state-level work as an effort to improve the system around clinics and patients.

Highpower served as a model for the state’s expansion of treatment, but the need far exceeded available capacity. Federal rules at the time limited certified medication-assisted-treatment doctors to 100 patients, a cap later raised to 275 in response to the crisis. Even as access broadened, treatment remained slow to reach many communities. Emergency departments and referral programs struggled with provider shortages and inadequate treatment beds, illustrating the gap between identifying a need and securing ongoing care.

Treatment, Diversion, and the Limits of Access

The book places Highpower within a longstanding American struggle to balance treatment with control of potentially misused drugs. Buprenorphine was among the best available tools for preventing opioid-related deaths, yet diversion, unsafe prescribing, and the abrupt loss of treatment could produce serious harms. The clinic’s combination of medication, screening, and counseling reflects an attempt to address these tensions without treating maintenance medication as a perfect or risk-free solution.

Highpower’s importance therefore rests on more than its role as a local provider. It shows how treatment standards are shaped by clinical practice, reimbursement, patient access, and regulation at once. The Meltons’ work linked a small rural clinic to statewide policy, while patient accounts from the clinic exposed problems that broader claims about medication treatment could overlook. In the book’s account, expanding care and confronting its shortcomings are not opposing tasks: both are necessary to make treatment more available and safer.