Sarah Melton

Sarah Melton is a pharmacy professor and statewide patient advocate whose account of addiction treatment resists an easy choice between medication and abstinence. She helps her husband, Hughes Melton, run Highpower, a rural Suboxone clinic, and brings both clinical concerns and oversight of prescribing into her work on Virginia’s opioid response.

Identity and Work

Sarah’s roles span pharmacy education, patient advocacy, and public health training. She was also a naloxone trainer: by 2017, she had given training sessions to more than four thousand doctors about opioid risks. The book presents her not simply as a supporter of treatment medication, but as an advocate attentive to how it is prescribed and used.

Her work takes place against a backdrop of rural communities facing economic hardship and uneven access to care. The book connects the opioid crisis to the collapse of work, rising disability, and the expansion of painkiller supply. In that context, Sarah’s attention to both treatment and prescribing practices addresses different parts of the same crisis rather than treating addiction as an isolated matter of individual conduct.

Highpower and Treatment Practice

Sarah helps Hughes run Highpower, their clinic in Lebanon. Its approach includes strict urine-screening protocols and on-site group and individual counseling. These procedures distinguish the clinic’s model from accounts in the book of treatment providers prescribing more medication than patients needed, with some patients selling the surplus to pay for return visits.

Sarah described Suboxone, which combines buprenorphine with naloxone, as a valuable medicine. At the same time, she said that she had seen deaths involving Subutex, the buprenorphine-only formulation. Without the added naloxone blocker, Subutex was more attractive to some users who wanted the option of taking other opioids, including Percocet, to get high. Her account makes the distinction between the formulations consequential: medication can support treatment, while prescribing choices and diversion can create serious risks.

Advocacy and Oversight

Sarah’s advocacy includes challenging overprescribing within the treatment system itself. She reported a number of physicians for prescribing opioids excessively, extending her scrutiny beyond the pharmaceutical companies and prescribers associated with the earlier painkiller crisis. The book places this work beside Virginia’s effort to expand treatment while tightening controls on medication prescribing.

Several patients first explained the diversion and abuse of buprenorphine to the author at Highpower. Sarah’s experience therefore complicates a debate in which concerns about medication misuse could be dismissed as incompatible with support for treatment. Her position, as described in the book, is that medication can be important and that its delivery requires meaningful safeguards, counseling, and attention to what patients encounter in practice.

Significance

Sarah’s account gives the book a view of treatment that is neither uncritical promotion nor blanket rejection of medication. The clinic’s screening and counseling, her training of thousands of doctors, and her reports of overprescribing all point to the same practical tension: expanding access matters, but access without responsible prescribing can reproduce harm. Her work makes that tension visible within the treatment system, where the need to help patients and the risk of misuse coexist.