Brian Chan and his colleagues recently published a paper titled “Mobile Methadone Medication Unit: A Brief History, Scoping Review and Research Opportunity”
“Mobile methadone medication units (“methadone vans”) emerged in the late 1980s to respond to the spread of HIV infection among people who use drugs and the need to enhance access to opioid treatment programs. The purpose of the vans was to facilitate access to care in rural communities and in urban areas when communities opposed the opening of fixed site opioid treatment programs (OTPs). The Drug Enforcement Administration (DEA) approved the first “clinic on wheels” as a medication unit serving communities in Southeastern Massachusetts 1988.” [12]
AATOD has worked with the DEA with regard to permitting/allowing the use of mobile vans to work under the aegis of licensed and accredited OTPs.
After several years of consideration, the DEA released new mobile van regulations on June 28, 2021.[13] In our judgment, AATOD sees three broad applications in using such vans. The first pertains to the more standard use of such vans, which extends the reach of OTPs in surrounding communities. The DEA has simplified the process of acquiring such vans, although other issues must be considered, including the purchase price of these mobile components, grant support to the OTPs to purchase the vans, and the services provided through such vans.
The second broad application is how such vans could work with the justice system. In this case, the OTPs would work with the State Opioid Treatment Authorities as well as the Departments of Corrections. The goal would be to have the OTP dispatch such vans to correctional facilities, including jails and prisons, where the OTP van personnel would induct patients onto one of the three federally approved medications to treat opioid use disorder and would maintain inmates on these medications until the time of their release. These patients/inmates would also receive additional clinical services to support the use of these medications during their period of incarceration and transition back into the community. Van personnel or correctional program personnel would work in cooperation with program personnel to coordinate a seamless handoff to a community-based provider so patients can be admitted into the OTP or a DATA 2000 practice upon release in an effort to continue treatment.
The third application would be to use such vans to provide, expand, and enhance access to care for people with opioid use disorder in residential settings. These settings could include recovery homes, which are classified as medication free facilities, skilled nursing facilities and nursing homes, in addition to many other site needs. It is understood that such mobile vans are expensive, and AATOD recommends that federal and state funding be used to assist OTPs to purchase such vans. We emphasize the importance of the SAMHSA communication of August 4, 2021.
“SAMHSA supports the use of the Substance Abuse Prevention and Treatment (SAPT) Block Grant funds for mobile units for the purpose of providing substance use disorder outreach, screening, assessment, treatment and recovery support services.” [14]
The Department of Agriculture appears to have funding ability for OTPs to purchase such vans as long as the services would operate in a rural population of 50,000 people or less. AATOD completely supports these funding initiatives in this policy arena.
