Researchers recently transformed an RV into a mobile telemedicine unit to provide treatment for opioid use disorders and deployed it in rural areas of Maryland for more than a year. The results of the trial, published in JAMA Network Open late last month, found the innovative approach was as successful as conventional treatment clinics. With rural communities disproportionately affected by the opioid epidemic and lacking treatment programs, the success of the mobile treatment program could offer a potential way to bring more support to those areas.
Treating Opioid Use Disorder in an RV
For the study, researchers from the University of Maryland School of Medicine reconfigured an RV into a traveling treatment center for opioid use disorder. It features a private meeting room for patients to have a video conference with a doctor who specializes in addiction psychiatry and medicine, a bathroom for an observed urine collection, and a waiting area. The RV is staffed by a nurse and substance use counselor, along with a peer recovery specialist, who can play an important role in helping people through recovery, says Courtney Zongrone, a licensed professional counselor at Thriveworks in Blacksburg, Virginia. “These individuals are essential to the recovery process and can offer patients an additional level of support that substance use disorder counselors and medical providers have to be more careful in navigating,” she says. People can get treated on the RV on a walk-in basis, or through a prescheduled appointment. After a person completes the initial evaluation, which takes about 45 minutes, they get a prescription for naloxone (a medication that can rapidly reverse an opioid overdose) or buprenorphine (a medication that can treat opioid use disorders) sent directly to their local pharmacy. The mobile telemedicine center staff also help coordinate the patients’ follow-up visits, which can take place on the RV and usually last 20 minutes.
Testing Mobile Treatment for Opioid Use Disorder
To test how well this approach could work, the researchers parked the RV in church parking lots in four rural towns along the Eastern Shore region of Maryland, from February 2019 to June 2020, during which 118 people enrolled in treatment for opioid addiction. The researchers evaluated data on a subset of 94 people who had returned to the RV for at least one follow-up visit. That group skewed 63% male, majority White, and had an average age of nearly 37 years old. All met the criteria for having an opioid use disorder, and nearly all of their initial urine samples tested positive for recent opioid use. The results showed that the RV offered similar levels of treatment success as traditional in-person substance use treatment programs, with 64% of participants remaining in treatment after two months and 58% after three months. Opioid use dropped by nearly a third after three months—a rate similar to what’s seen at conventional clinics. “Despite the single group design, the study proves that bringing medications for opioid use disorder to underserved communities can have an overall positive impact,” says Fred Muench, PhD, a clinical psychologist and president at the Partnership to End Addiction. “It is all about making it easy for people. Digital technologies where someone does not have to exert so much effort to get care is the key.” Not only was the program successful, it also came at “a considerable convenience” to the participants, the researchers say. The RV saved patients about 6.5 miles (or about 10 minutes) of driving for each treatment visit compared with how long it would have taken them to reach their nearest brick-and-mortar treatment clinic, on average. “The program was started as a clinical expansion of an existing telemedicine initiative for treating individuals with opioid use disorder in Caroline County, Maryland. Our team realized that there were a group of individuals that could not access treatment in the brick-and-mortar clinic located at the Caroline County Health Department due to transportation issues,” says the study’s lead author, Eric Weintraub, MD, professor of psychiatry and division head of addiction research and treatment at the University of Maryland School of Medicine. He adds that he was surprised by just how many people sought treatment from the RV. “We are caring for individuals in several small towns in one very small county in Maryland, and yet we have consistently needed to expand our hours to accommodate everyone who wants treatment,” says Dr. Weintraub. “Our experience demonstrates that there are many individuals in rural areas that need but have difficulty accessing treatment for logistical reasons.”
Breaking Down Barriers to Treatment
Given that the RV program was shown to be as successful as conventional clinics at treating opioid use disorder, it may be uniquely well-positioned to provide support to underserved communities, particularly in rural areas. “Rural communities have a particular challenge in supporting their community members due to the same reasons why this study was conducted: access to resources,” says Zongrone. “Rural community members may experience an increase in opioid use disorders merely because of proximity to resources which urban community members can access more easily and frequently [on public transportation.]” Another important challenge the RV addresses is the lack of access to buprenorphine in rural areas. While the medication can make someone nearly twice as likely to stay in opioid use disorder treatment, it can only be prescribed by doctors and other healthcare professionals who’ve met certain qualifications and applied for a special waiver from the Drug Enforcement Administration. The hurdles have left more than half of the country’s rural counties without a single doctor who can prescribe buprenorphine amid an ongoing shortage of treatment programs. “The use of mobile telemedicine can bridge that gap and bring in expertise from distant sites including academic medical centers,” says Dr. Weintraub. But simply proving that mobile treatment for opioid use disorders can be effective isn’t enough to get care where it’s most needed. These programs need money from the government and other organizations in order to expand and reach more people. “What we learned is that we needed support from both the state and local level to put together the RV telemedicine model,” says Dr. Weintraub. Stigmas against addiction can make it difficult to direct enough funding to develop similar telemedicine units in other areas. But with opioids continuing to be the main driver of drug overdose deaths, increasing funding for innovative programs that can treat opioid use disorders is critically important. “The more money we put into helping people get care and sustaining a life with connection and meaning during recovery, the more we will be able to stop repeated relapses and addiction,” says Dr. Muench. Not only has it been shown to offer similar success rates as conventional brick-and-mortar clinics, the mobile clinic also increases access to treatment for people who may lack public transportation or live in an area with a shortage of healthcare professionals qualified to treat addiction. But before we see programs like this rolled out in other areas of the country, governments and other organizations will need to increase funding and overcome stigmas against addiction.
