Markian Hawryluk / Kaiser Health News
Tonja Jimenez is far from the only person driving an RV along Colorado’s rural highways. But unlike the other trucks, his 34-foot-long RV is outfitted as an addiction treatment clinic on wheels, bringing lifesaving care to the northeastern corner of the state, where patients with substance use disorders are often left. to themselves.
As in many states, access to addiction treatment remains a challenge in Colorado, so a new state program has turned six RVs into mobile clinics to reach isolated farming communities and remote mountain villages. In recent months, they have become even more crucial: During the coronavirus pandemic, even as brick and mortar addiction clinics closed or stopped hiring new patients, these six-wheeled clinics practically moved on.
Their healthcare teams perform in-person testing and counseling. And because broadband access isn’t always a given in these rural places, RVs also provide a telemedicine bridge for health care providers in large cities. Working remotely, these providers can prescribe drugs to combat addiction and the ever-present risk of overdose, a particularly looming concern in the isolation and stress of the pandemic.
Mobile health clinics have been around for years and take vision tests, asthma care, and dentistry to places with no proper care. But using health care on wheels to treat addiction isn’t that common. Nor is equipping RVs with telemedicine capability that allows prescription providers to treat hard-to-reach patients in these hard-to-reach rural areas.
“We truly believe we are bringing the treatment to our patients and we meet them where they are,” says Donna Goldstrom, clinical director of Front Range Clinic, a facility in Fort Collins, Colorado, which operates four RVs. “So meeting them where they are physically is not a big leap from meeting them where they are motivational and psychologically.”
Each camper has a nurse, counselor, and peer specialist who has personal experience with addiction, and they all had to be trained to drive a vehicle of that size.
“When I went to nursing school I never thought I would,” says Christi Couron, a licensed practical nurse, as she pumps 52 gallons of diesel fuel at one of the RV clinics.
His crew has driven his RV more than 30,000 miles since January, largely seen through a cracked windshield – courtesy of a summer hail in the afternoon. Four days a week they ply the roads from Greeley to smaller towns near the Nebraska border, as the view ranges from a mile high to a mile wide.
Put on a mask, pee in a cup
On dusty ground outside a nursing home in Sterling, Jimenez, the peer specialist, activates the leveling jacks to balance the RV, and the team prepares the unit for the day’s patient list. The captain’s chair on the passenger side turns to be in front of a table where Jimenez will monitor patients. The tabletop is filled with a printer, scanner, laptop, and label maker. Below lie a box of sample cups and a gallon of washer fluid. The vehicle now also has many masks and cleaning products on hand.
After check-in, patients go to the camper’s cozy bathroom to provide a urine sample. With test strips built into the sides of the cup, the results instantly show if there is any of 13 drug categories, from opiates to antidepressants, in the urine. The sample is subsequently delivered to a laboratory to confirm the results and determine which specific drug is involved. The findings help the team understand how best to treat patients and make sure they use the prescriptions they receive.
Markian Hawryluk / Kaiser Health News
Patients then head to a small examination room in the back, where they connect via video to a nurse or medical assistant in a physical clinic.
Hopefully, the provider will send a prescription for Suboxone (a combination medicine containing buprenorphine, which blocks opioid cravings) or Vivitrol (a long-acting injectable version of naltrexone, which blocks opioid receptors). Once the staff has the prescription in hand, the camper nurse can directly administer those shots of Vivitrol and also distribute Narcan, a drug that will reverse an opioid overdose. Suboxone prescriptions should be called at a local pharmacy.
Patients can also drop used needles into a sharps container in the RV for disposal, but staff are not authorized to distribute clean needles. Some patients will speak to counselor Nicky McLean in a room large enough to hold a table and two chairs.
Within minutes, a couple, asking not to be identified by name due to the stigma surrounding the addiction, arrive early for their dates. They brought the homemade chicken enchiladas. They had spent $ 8,000 a month to buy OxyContin on the street, and their lives and finances are a wreck. He lost his home. He needs clean urine tests to see his son. The couple started addiction treatment just three weeks earlier, after learning about the VR clinic from a friend.
They no longer have a car, so they walked half an hour to get to the appointment.
“We would have done anything to get our drugs,” he says. “Walk 30 minutes to get better – it’s worth it.”
Even before they’re done, another patient is at the door. Spencer Nash, 29, has been using opioids since she was 18. Nine years ago, when his wife became pregnant, the couple decided to seek treatment by driving two hours each way, six days a week, to a methadone clinic in Fort Collins. Now he goes to the camper, outside the nursing home where he lives, to get his prescription of Suboxone.
Fill the gaps
A few years ago, Robert Werthwein, director of the Colorado Office of Behavioral Health, heard about a project using RVs for addiction treatment in rural New York state. He thought it would work in his state as well. The agency analyzed the numbers to see which regions had the highest opioid prescription and the most overdoses but had no treatment for addiction.
“We hear too often that rural Colorado and mountainous Colorado regions don’t have the same access to Metro Denver and Front Range services,” says Werthwein. The state has secured a $ 10 million federal grant for the program. His team brought health workers, such as Front Range Clinic, to the staff and management of the RVs.
Once the RVs were ready, staff had to be trained to drive them, which required “a couple of repairs,” says Werthwein. The vehicles first started running in December, eventually serving six regions – and in a seventh area, a place where narrow mountain roads preclude a large RV, one of Werthwein’s teams travels in an SUV.
In some communities, local doctors and others have been less than enthusiastic, fearing that the RVs would lure drug addicts to their town.
“We hope to address the stigma, not only from a public perspective, but we hope to show suppliers’ there is a demand in your community for drug treatment,” says Werthwein.
Once the federal grant expires in September 2022, Front Range Clinic and other mobile unit operators will inherit and continue to operate RVs, billing Medicaid and private insurance as they do now for appointments.
As the crew of the RV is at 1pm the departure time in Sterling approaches, a patient remains. The woman, who asks that her name not be published because she does not want to be publicly identified as a drug addict, arrives at the mobile clinic without an appointment.
But the staff can’t take her as a new patient without a urine sample. For two hours she goes in and out of the bathroom, drinks bottles of water, but can’t fill the plastic cup. Through the bathroom door, she can hear herself crying and cursing at herself.
With the battery on the camper running low, the staff convinces her to get out of the bathroom. Maybe tomorrow would work better, they tell her. He may continue to rehydrate through the night and then meet the mobile unit at the next stop, Fort Morgan, about 45 minutes away.
The next day, he is still unable to produce a urine sample, either due to dehydration from substance use or just nerves. They ask her to come back again when the RV returns to Sterling next week, but she never shows up.
Kaiser Health News is a non-profit, editorial independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente