Franklin McClain sat behind the wheel of an extended cargo van that he navigated out of the parking lot at Liberation Programs outpatient center in Bridgeport and onto nearby streets.
He wore a rainbow tie-dye T-shirt -- it exactly matches the colorful exterior of the van, which also has lettering at the top that says, “Peace, Love and Liberation.”
“These signs on here mean a lot to me. Peace and love,” he said. “It’s so important on the street, because they don’t get that at home. They don’t get that at home, so when they see that, they’d be like, wow, you know.”
McClain spoke about people suffering from an opioid or substance use disorder. The staff on the wellness van go out into Bridgeport neighborhoods multiple times a day to distribute clean syringes and fentanyl testing strips, first-aid items, the overdose reversal medication naloxone, and other harm reduction supplies.
And now, because of a recent federal rule that lifts a 14-year ban on mobile methadone vans, Joanne Montgomery hopes Liberation Programs will soon be able to dispense methadone on their existing vans and expand access to the medication in local communities.
“We think it’s going to be a big success, and we think it’s something that’s been needed,” she said. “We’ve been looking to do this for years, and we were very excited when the feds said, ‘You know what, we’re going to approve this.’”
Methadone is the oldest and most widely used medication to treat opioid use disorder, but it’s also the most tightly regulated kind of medication-assisted treatment, mostly due to its status as a schedule II narcotic.
Registered narcotic treatment providers were once allowed to add mobile methadone vans to their brick-and-mortar operations in order to get the medication to more patients. But in 2007, the U.S. Drug Enforcement Administration stopped approving any new mobile program applications.
With a death toll that continues to rise -- an estimated 93,331 people died from a drug overdose nationwide in 2020 -- and mounting pressure from treatment providers, the federal agency lifted the ban, effective July 28.
“This has been a long time coming,” said Robert Lambert, president and executive director of Connecticut Counseling Centers Inc. “On a national level, it’ll be important for rural areas, a game changer. Connecticut is not as rural, but vans could help bring treatment to the prison system, patients in skilled living facilities, people who are homebound with disabilities.”
Montgomery, Liberation Programs’ chief clinical and outreach officer, and McClain, outreach coordinator and recovery coach, work together at the Bridgeport site, home to one of Connecticut’s 25 licensed methadone clinics.
Under current state and federal rules, most people with an opioid use disorder can only get maintenance methadone treatment by showing up in person at a clinic every day. They’re often supervised as they orally take their dose of the liquid medication.
Dispensing regulations are intended to ensure the medication’s safety and effectiveness for patients, and to make sure it’s not being misused. But the requirements can become barriers to treatment for people who lack the ability, time or resources to make daily physical trips to a clinic.
Montgomery added that there continues to be a lot of stigma around methadone, a synthetic opioid that’s been used since the 1960s to reduce painful withdrawal symptoms and block or limit the euphoric effects of opioid addiction.
“Clients do not want to walk into a clinic for fear that they may see someone who knows them and their business will get back to their job, their families, whomever,” she said. “So, if we’re parked somewhere secluded where people can come up and feel comfortable that they’re not going to be in a big space with a few hundred people seeing them, we think we’re going to get a lot more people.”
When the DEA placed its moratorium on new mobile methadone vans, there wasn’t much explanation for the move. Some reports indicated the federal agency was concerned that the medication would be diverted, or used illegally, despite little evidence supporting that theory.
Mobile methadone vans that were already established could continue operating. As of today, fewer than 10 are still in existence -- none of them are in Connecticut.
Mark Rubbins, diversion program manager at the DEA’s New England Field Division, can’t speak to the decision making behind the 2007 ban but said there is a lot of support for vans today.
“Obviously, the opioid epidemic has devastated communities in New England, both rural and urban,” he said, “and this is just another tool in the toolbox that treatment providers have that they can deploy to get adequate treatment to people.”
Mobile methadone vans will need to comply with safety and security requirements. They involve installing safes for the treatment medication, designating a medical storage area that is separate from the patient area, diligent record keeping, and returning the vehicle and all methadone on board to a treatment provider’s permanent, physical location at the end of each day.
With these measures in place, Rubbins said there’s little concern at the DEA that methadone will be stolen, diverted or misused on the vans.
Organizations must be licensed to dispense methadone in order to apply for a mobile van program. The application process may move quicker for provider organizations that have already invested in commercial-style vehicles that they could convert or modify for methadone dispensing.
“We have a physician assistant who’s very excited about it, our medical team is behind it, our clinical team is behind it, and we’re ready to go,” Montgomery said. “The only issue right now is Connecticut is looking and making its own regulations.”
In an email, state officials said the Connecticut departments of Mental Health and Addiction Services and Public Health “are engaged in collaborative discussions related to regulation modifications that may be necessary to allow for the dispensing of methadone from a mobile [narcotic treatment provider].”
The state did not indicate when any local regulations will be finalized, but leaders in the addiction treatment community hope the departments will move quickly.
Since the federal moratorium ended in late July, Rubbins said new applications to register a mobile methadone van have been few in number, despite the 1,930 narcotic treatment programs in the U.S. currently registered with the DEA. But Rubbins estimated that mobile vans will gain traction as time goes on.
“I think a lot of people are dealing with the COVID-19 pandemic, so that’s sort of been their focus. This may not have been on the radar, because they’re dealing with COVID, making sure staff is there and people are getting services,” he said. “This is a valuable treatment alternative. I assume many existing registrants will add this to their options.”
