“Who is missing from our meetings?”

Recently, I came across the 2026 Conference Agenda Report from the World Service Conference of Narcotics Anonymous.

A recent post on Narcotics Anonymous sparked a lot of online discussion. It focused on professionals’ lack of cognitive empathy and condescension toward NA.

. . . they frame the ~250,000 Narcotics Anonymous members who are lay people, gathering in their free time, charge nothing, receive no funding, and do no lobbying, as agents of stigma who lack sufficient compassion, reject science, and are insufficiently committed to the recovery of all people with drug problems.

. . .

Imagine if, instead of all that effort demanding these unpaid nonprofessions solve their patients’ needs, they put that effort into supporting, organizing, and developing mutual aid for those >4 million people on agonist treatments. Imagine what a group like Medication Assisted Recovery Anonymous (MARA) might be with that energy and commitment.

The conflict arises from the perceived value of the social support that can be found in NA and NA defining recovery in a manner that places opioid agonist treatments outside of recovery’s boundaries.

We talk a lot about the importance of lived experience, but the NA lived experience, which I’d imagine includes a lot of firsthand experience with opioid agonists, is treated as problematic.

Some of the objections frame forcing people to choose between social support and life-saving medical care as a systemic failure. I agree that it’s a systemic failure, but is it a failure on the part of NA or professional caregivers?

Some of the objections pointed out that agonist patients’ needs for social support are immediate and can’t wait for the development of mutual aid for agonist patients.

I see it as a systemic failure of professional helping systems. NA is just a group of people who were failed by social and professional helping systems and self-organized to develop a model and network to help themselves and others recover without any funding or fees. If mutual aid for agonist patients had developed and grown with the growth of agonist treatments, few people would care about how NA defined recovery. Professional systems can keep demanding that NA change to meet the needs of their patients or attempt to develop the support their patients need. Yes, it will take time. The best time was 23 years ago; the second-best time is now.

All of that is a rehash of the previous post; this post is meant to share a few interesting snippets from the 2026 Conference Agenda Report from the World Service Conference of Narcotics Anonymous. How NA responds to these questions is an internal matter, and this report gives a rare peek into the fellowship’s discernment process.

NA identifies Internal Discussion Topics (IDTs) to guide discernment around the fellowship and during the World Service Conference.

Here’s some background:

We have been talking about one or another form of drug replacement therapy for many years. In the 1990s, the Board of Trustees issued a bulletin on the subject. In 2006, when we asked in an IDT “Who is missing from our meetings?” those on medication for addiction were acknowledged as a population

On the potential intractability of the issue:

This is not a casual disagreement. For many of us, it goes to the heart of our understanding of what Narcotics Anonymous is and what our recovery means. We cannot make light of this or pretend that the challenge is something we can gloss over. To say we are not in a position to solve it is to acknowledge the gravity of this for so many of our members. This is actually a matter of life and death: If we were to pick any side, addicts would leave and die. And to many of those whose positions are fixed, the answer seems clear and obvious.

On the threshold for membership, the ideal of a classless fellowship that doesn’t interrogate its prospective and current members:

In the words of one member, “Some of us circle the airport a long time before we come in for a landing.” Membership requires only a desire to stop using, and we don’t have classes of members. It is not our job to determine what someone takes or what their relationship to it is. It is our job to help the member answer that themselves, with guidance from their sponsor and Higher Power.

On NA’s relationship to treatment and stability as a starting point rather than endpoint:

We are forever nonprofessional, and in some ways as an organization, we opt out of the conversation happening in the field of addiction treatment. We understand that addiction treatment is almost always about people in transition from active addiction to some form of recovery. NA’s approach doesn’t end with stability, but in so many ways begins here. We respect the professionals in the field and acknowledge that their approaches change over time and across disciplines. Our approach does not change. We are addicts seeking recovery together, and what we offer is a spiritual path in fellowship with others.

On its relationship to science and its spiritual nature:

Narcotics Anonymous is a spiritual program, a Fellowship of people, a program of action. It is not a science, nor is it engaged in the practice of science, although we are grateful for those researchers who have been able to reflect us back to ourselves through their lens.

On living together in unity without unanimity:

Our diversity is our strength, not only with regard to demographics, but also in our approaches to recovery. This is not to say that our message is “watered down,” but that our experience is precisely this: Our Basic Text tells us, we come to an understanding of the program for ourselves, and with our diverse understandings we peacefully coexist in the spirit of our First Tradition. Though there are many things we don’t agree on, we share a message, a purpose, a program, and a set of principles that guide us through deep waters. Learning to live together in unity—without unanimity—asks us to practice equanimity

It’s time for us to change the conversation with the understanding that our members do not agree with one another about MAT. Focusing on what we do agree on allows us to move forward. We may find that NA communities address issues of service and celebration differently from one another, just as we may find that some sponsors regard medication differently from one another. And maybe that’s okay. Meanwhile, we can reconfirm our consensus and focus our energy on welcoming addicts, supporting them, and retaining them to the point where they can come to an understanding for themselves.

I’d known there was discord and active internal discussion within NA about how to respond to the dramatic changes in the treatment experiences of people with opioid addiction (prospective members) over the last couple of decades, but I had no line of sight into that discussion.

NA was born out of attempts from professional and social systems to control addicts and reduce negative externalities like crime and disease transmission. Where those systems did try to help addicts, they typically settled for stabilization. This often involved medication and is not something of the distant past. NA was born of a desire for more than stabilization and a realization that addicts couldn’t rely on professional systems to facilitate it. Integrating that lived experience with agonist patients referred to NA is no small matter. It’s for them to sort out, and I hope they chart a path that’s internally directed, whatever that is.