Alison Knopf
The importance of paying more for mobile than brick and mortar methadone
Linda Hurley, CEO of CODAC Behavioral Healthcare in Rhode Island, explains the value of both brick and mortar opioid treatment programs (OTPs) and mobile vans, but also why delivering treatment in mobile vans can be more expensive than in OTPs. In addition, she explains by both are necessary.
CODAC launched the first mobile medical unit to be approved under the new Drug Enforcement Administration (DEA) regulations (see https://atforum.com/2022/08/methadone-van-codac-approved/).
The need for redundancy: “What happens to patients if there is only a single unit for your municipality and your unit breaks down? Or if your electrical system didn’t charge?,” asks Hurley. “There are 100 things that can go wrong. And there’s a remarkably high percentage of physical barriers to care” in mobile vans, compared to brick and mortar.
Staff: Mobile staff need more experience than brick and mortar staff because the number is limited due to space. In addition, they are isolated. So in a moment of crisis, or in a moment of immediate need, they need access to supervision. “So you can’t have entry level staff go out in a mobile van,” said Hurley.
Culture: For maximum effectiveness, it’s important for staff to be culturally congruent to the patient population, said Hurley. “If someone is going out into latino populations, into Cape Verdian populations, you need to be able to speak that language,” she said. “If a staff member is bi- or tri-lingual, we’re paying more for that.”
Maintenance: The physical units must have a dispensary approved by the Drug Enforcement Administration, noted Hurley. “These are not recreational vehicles,” she said. “These vans weren’t designed for the hard work” that mobile methadone entails. “They’re not designed to go out all day every day of the year. There’s a small heavy expensive safe. The generator system breaks. The hydraulics break.”
Finally, CODAC pays peer support and community care managers to drive their own vehicles so they can be alongside the van, she said. This is an additional cost.
Hurley, a leader in the methadone treatment field, thinks it should be easier for patients to access treatment. “Ethically I feel we are responsible to do more, in terms of transportation and more,” she said. “There is a deeper ability to provide linkages for care. When you take a mobile unit out, you have the understanding that you are going to people who can’t come to you in your brick and mortar facility. So you have to have wraparound services.”
But don’t make the mistake of thinking mobile methadone is less expensive than brick and mortar. It isn’t. And it’s not a replacement for brick and mortar. Both are needed.
Linda Hurley