How do mobile methadone clinics work, and what are Philly’s plans for opening one?

For many people with opioid addiction, getting treatment isn’t simply about finding the right doctor. Heavy federal restrictions around methadone — one of the most effective addiction medications — can keep this lifesaving treatment out of reach for those who lack housing, or transportation, or can’t take time off at work.

Rhode Island is testing a solution to get around these barriers to treatment: a methadone clinic that operates out of a van to get medication to vulnerable patients.

The clinic’s first stop? An encampment of people with addiction living outdoors in tents in Woonsocket, R.I.

“Telling them they can get on a bus, drive 20 minutes, and wait at a clinic — well, half their stuff will get stolen from their tent while they’re gone,” said Linda Hurley, the president of the nonprofit running the clinics. “It was asking a lot.”

Now, the clinic treats about 40 people from the encampment on a daily basis, right where they live. It’s a model that other cities around the country, including Philadelphia, are looking to follow now that the federal government has lifted restrictions around mobile methadone clinics.

Earlier this year, Philadelphia announced that it would use part of a $1.6 billion settlement from a lawsuit against opioid manufacturers to fund mobile methadone clinics in an effort to get people with addiction into treatment as quickly as possible.

Mobile clinics can reach people who would have difficulty driving or taking public transportation to a brick-and-mortar clinic, and can also visit communities where no permanent clinics exist.

Between 2007 and 2021, the federal government had banned the approval of any new mobile methadone clinics, leaving just a handful operating around the country. Since that ban lifted, cities in Rhode Island and New Jersey have already launched mobile methadone clinics. (In some parts of the world, mobile methadone clinics are widely deployed to treat addiction, like the system in Portugal that serves hundreds of people daily.)

Philadelphia hopes to join the places using the concept to expand access to treatment within the next year.

Methadone is an opioid long used to treat people addicted to opioids. It’s longer-acting than many opioids sold on the street, like heroin and fentanyl, and helps people with addictions stave off painful withdrawal symptoms like nausea, craving, and cramps.

However, methadone is heavily regulated by the federal government, much more so than any other opioid addiction treatment. Unlike buprenorphine, another opioid addiction medication that any doctor authorized to prescribe drugs can offer, methadone can be dispensed only from specially licensed clinics.

Most patients on methadone must visit a clinic to take it under supervision every day. Only patients deemed “stable” enough can take a supply home, typically two weeks’ to a month’s worth of doses.

Though the federal government relaxed some of the restrictions around take-home methadone during the pandemic, many people with addiction avoid methadone because the requirements around it can make it hard to keep a job, travel, or plan for emergencies.

New Jersey, one of the few states running mobile methadone clinics before the federal ban, was allowed to operate five between 2007 and 2021. Now, the state expects to add three more vans, Tom Hester, the communications director for the New Jersey Department of Human Services, wrote in an email.

One of the state’s vans parks outside a prison to treat incarcerated people. People in prisons and jails, in New Jersey and elsewhere, have high rates of addiction and are often met with significant barriers to getting adequate treatment.

In Woonsocket, taking methadone directly to the encampment helped more people consider treatment as a viable option, said Hurley, the president and CEO of CODAC Behavioral Healthcare, which runs the mobile clinics. But people experiencing homelessness are not the only population the mobile clinic serves: “We have people who work highly visible, highly professional jobs where this is just the easiest way to get their medicine,” she said. “It’s a full range of folks who need us.”

Getting up and running has seen challenges. It took six months for CODAC to order a specially made safe to secure its methadone — as required by federal regulations — that was heavy enough to deter break-ins and lightweight enough to be transported in a van, Hurley said.

“It literally makes me feel ill, how many people may have died while waiting those six months before the service got to them,” she said.

Then in December, local officials in Woonsocket issued the van a cease-and-desist order, saying it was offering medical services in an area not zoned for them.

Hurley said her organization has not received any direct complaints from residents or city officials. The van stops in a parking lot of another nonprofit organization that cares for people in addiction, and both organizations believed that they did not need a special permit to operate the van, Hurley said.

The van is still operating, Hurley said. Officials from Woonsocket’s law department were not immediately available for comment.

Brick-and-mortar methadone clinics, too, often face significant community opposition, including in Philadelphia, where City Council members have used zoning laws to block the opening of new methadone clinics.

The city wants its mobile methadone clinics to start patients on methadone the same day they show up at a van. While some brick-and-mortar clinics do this already, others take longer to accept patients, said Hurley.

“We think it’s going to be a game changer for the city and for individuals who are seeking services,” said Amanda David, the chief program officer for the city’s Department of Behavioral Health and Intellectual disAbility Services.

David hopes that patients in Philly will start on methadone at mobile clinics and then continue on to brick-and-mortar buildings when they’re more stable in recovery.

City officials expect to post an application for potential van operators this spring. (Under federal regulations, new methadone vans have to be associated with an existing methadone clinic.)

The city hasn’t decided where the vans will stop, David said, and plans to use data and seek input from communities to make decisions.