John Hayes literally has a front-row seat to the widening demographics of opioid addiction.
He’s a driver of CODAC Behavioral Healthcare’s new mobile clinic, a converted recreational vehicle that recently started visiting addiction “hot spots” in Woonsocket, Providence and Pawtucket, offering treatment for substance use disorder to people who have made an appointment or handing out harm-reduction kits equipped with fentanyl-testing strips and Narcan nasal spray.
On a recent morning, Hayes was immersed in a task not found in his job description. A patient in Woonsocket had come to the mobile unit from a homeless encampment where the tent he lived in with his girlfriend had been ransacked. The couple had become separated, and the man feared she would relapse. He needed help finding her.
After a call on a borrowed cellphone, the two were eventually reunited.
“Everything they own is in a trash bag,” Hayes said. “But they keep coming back.”
And he sees the other end of the spectrum through the windshield of the mobile unit – people with homes and jobs who are fighting addiction before they lose everything.
“People will come in before they go to work,” he said. “I’ve seen guys pull up in company trucks [to receive medication].”
CODAC says the 27-foot-long vehicle – which hit the road this summer – is the first mobile treatment unit for opioid addiction in the country to receive federal approval under U.S. Drug Enforcement Administration regulations that took effect in July 2021.
After receiving the go-ahead following a lengthy review process, the $300,000 mobile clinic, purchased through a grant received by The Champlin Foundation, was cleared for operation.
“We needed to be out there,” CODAC CEO Linda Hurley said.
Advocates say flexibility and mobility are required to mitigate a crisis that in Rhode Island left 435 people dead in 2021, the highest number ever recorded, according to the R.I. Department of Health. This year, the number of fatal overdoses in the state is poised to climb even higher than that.
The epidemic has hit Woonsocket especially hard, part of the reason Community Care Alliance invited CODAC to its premises, the alliance’s CEO Ben Lessing says.
Woonsocket had 39 fatal drug overdoses in 2021, a 170% increase from 2019, according to RIDOH. Lessing says the agency has seen a spike in city residents seeking services since the mobile unit was first parked in the alliance’s lot In July.
“We have definitely seen an uptick of activity,” he said. “We try to use it as an opportunity to be as comprehensive as possible in terms of wraparound services ... so it’s a natural fit.”
Dr. Brandon Marshall, a researcher and professor of epidemiology at the Brown University School of Public Health, estimates there are more than 10,000 people in Rhode Island who could still benefit from these treatments.
“What we know is there are significant treatment gaps. And services like these mobile units play a critical role,” he said.
Inside the vehicle, the clinic has a dispensary and treatment rooms, a separate waiting area and a restroom. It is equipped for telehealth counseling and staffed by a doctor on alternating days, with a nurse on-site from 6:30 to 10 a.m. in Woonsocket. Most people interested in receiving treatment for substance use disorder must make an appointment to receive methadone after an initial evaluation. But patients with an established medical provider or clinical relationship may receive what Hayes calls a “courtesy dose.”
The clinic conducts outreach services on weekday afternoons at various locations. Walk-ins can receive an evaluation by a case manager. Staff members will also assist with Medicaid applications and conduct general clinical procedures such as blood tests for HIV, blood pressure readings and mental health evaluations.
Offering help in the “hot spots” is critical, according to CODAC case manager Lexes Tavares.
She started a recent morning in Woonsocket attempting to assist a young woman in the throes of withdrawal. The woman told Tavares she was not interested in treatment, but rather a “play,” slang for finding narcotics. “She was just lying on the ground, asking for drugs,” said Tavares, before a truck pulled up and the woman disappeared.
She wasn’t ready to begin treatment, Tavares says, adding that it is a general policy for CODAC staff to refrain from intervening directly until those battling addiction take the first step. Tavares says she now has a caseload of 70 patients. The work involves treating those who have accepted clinical interventions while continuing outreach to others.
“We want them to know that we genuinely care about them,” she said. “Being in their backyard, eventually they get to know us by name. And that can plant the seed to recovery.”
Marshall, who also serves on the state’s Opioid Settlement Advisory Committee that recently issued recommendations on how to use the millions of dollars coming to the state from legal settlements against opioid manufacturers and distributors, says initiatives such as CODAC’s mobile clinic are part of a wider effort needed to properly address the epidemic.
Still, many regulatory roadblocks remain. “In the United States, the way we deliver methadone is arcane,” he said. “There are so many rules that we do not apply to other medications, including prescription opioids.”
But that could change, Marshall says. “Almost all of us have been impacted by this crisis directly. Many policymakers I speak to have had personal experience. So that is coming to bear with our response,” he said. “But we have a long way to go.”
Hayes says he has seen changes among the population CODAC aims to serve. A crisis that largely affected the underprivileged is now seeping into every corner of society.
“These days,” he said. “We all know somebody.”
