Date December 6, 2023
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Brown researchers study how mobile treatment clinics can help people find the road to recovery

A drug treatment clinic on wheels allows a Brown-affiliated E.R. doctor to treat patients and conduct research on ways to serve them and the community even more effectively.

WOONSOCKET, R.I. [Brown University] — Dr. Francesca Beaudoin, an addiction medicine specialist, emergency room physician and epidemiologist, has been on the frontlines of the opioid crisis for most of her career.

Early on, she saw its impacts during her residency as an E.R. doctor in the mid-2000s, when opioid prescribing was at its peak. According to Beaudoin, opioids were everywhere: “I was watching people come into the emergency room both trying to obtain opioid medications for an underlying opioid use disorder, but also people with ill-treated pain.”

Yet no one fully understood the crisis that was coming. “We didn't see the lights on the train in the tunnel at that time,” Beaudoin said.

By 2010, the epidemic was transitioning from prescription opioids to illicit opioids as well as fentanyl and its analogs. In response to what Beaudoin saw every day in the emergency room, she shifted her focus from pain management to the opioid crisis.

For the past year, Beaudoin, a professor of epidemiology at Brown University’s School of Public Health and a professor of emergency medicine at the Warren Alpert Medical School, has spent part of each week caring for people affected by the opioid crisis. But Beaudoin doesn’t see patients at a hospital or in a traditional clinic setting. Instead, she travels to Woonsocket, Rhode Island, where she works at a mobile recovery van on a busy, well-trafficked street near a bus stop.

The 27-foot-long R.V. is run by CODAC Behavioral Healthcare, a nonprofit based in nearby Cranston that provides treatment, recovery and prevention services to local individuals and families. Inside, there's a counseling room that can fit four, a bench where people can wait, a bathroom, desk, security system, refrigerator stocked with snacks and an area for dispensing medications like methadone, which blunts the effects of opioids and reduces cravings and withdrawal.

There are also staff members, including a nurse, a driver, a physician such as Beaudoin and peer recovery coaches who connect patients with insurance and help with housing, food and employment services.

Their goal is simple, Beaudoin said: To provide medication assisted treatment without the barriers or stigmas that often come with going to a clinic, in a flexible setting within the communities where people need it.

“We know that the proportion of methadone clinics that are in the community do not meet the needs of the patients — particularly when those patients don’t have housing or transportation,” Beaudoin said.

CODAC’s mobile unit, the first of its kind in the United States, is able to go directly to the areas where there are the highest rates of opioid overdose — it brings treatment to the people who needs it most. What’s more, Beaudoin added, when the van isn’t being used for methadone treatment, it can serve as a medical outreach unit, offering on-site treatment for people without housing, for example.

It took time for the idea of the recovery van to take off. At first, Beaudoin said, the staff focused on building awareness. “We spent a lot of time outside actually just talking to anybody that would come by to call attention,” she said. Eventually, word got out and people responded. There are now over 60 patients engaging with the unit, according to Beaudoin. 

A data-driven approach

The project has hit a few bumps in the road, Beaudoin acknowledged. There was some initial opposition from the City of Woonsocket, which served the program a cease and desist order, arguing that the R.V. was violating zoning laws. (Conversations with city leaders are ongoing.) There was also a tornado warning that forced staff and patients to evacuate to a nearby building.

Beaudoin realizes that for the concept of a mobile recovery program to gain traction and spread beyond Rhode Island, policymakers will need evidence not only of its effectiveness, but of the potential impacts to multiple stakeholders.

To test CODAC’s mobile unit, the behavioral healthcare organization is partnering with researchers at Brown's School of Public Health on a one-year study funded by the U.S. National Institute on Drug Abuse. Researchers are assessing the experiences of the mobile unit's patients and staff to identify barriers and facilitators to treatment. They will compare the health outcomes of mobile clinic patients to patients served by CODAC’s traditional brick-and-mortar treatment facilities.

By working directly with community organizations like CODAC, researchers can ensure the findings are directly relevant to practice and policy, said study co-leader Rosemarie Martin, a Brown associate professor of behavioral and social sciences who studies pharmacologic interventions for substance use disorders.

“Our research would not be nearly as robust or impactful without the critical contributions of community partnerships,” Martin said. “Research with partners, like this project with CODAC, has played an instrumental role in turning the tide of national and worldwide opinion about the use of medications for opioid use disorder.”

The opioid crisis remains a persistent local and national challenge, but Beaudoin is optimistic about the project’s ability to make an impact.

“Things are moving in a positive direction,” she said.

This story was adapted from an article that appeared in Continuum, the magazine for the Brown University School of Public Health.

An episode of the Humans in Public Health podcast features the voices of mobile clinic workers and patients.