Addiction treatment hits the road in North Carolina

By Rachel Crumpler

About a month ago, a young woman stopped by a bright green and blue bus parked outside the Alamance County Health Department, ready to start treatment for opioid use disorder. 

A mobile opioid treatment program — operating as a licensed extension of New Season Treatment Center’s Greensboro brick-and-mortar clinic — has been traveling to Burlington since January, bringing medications for opioid use disorder directly to Alamance County residents for the first time. 

“She didn’t have access to treatment,” said Preston Evans, program director of New Season’s Greensboro clinic who oversees the mobile unit. “She couldn’t travel all the way to Greensboro every day.” 

The mobile unit now parks about 10 minutes from the woman’s house, and she’s consistently shown up for treatment and is doing “really well,” Evans said. 

The U.S. Food and Drug Administration has approved three medications to treat opioid use disorder: buprenorphine, methadone and naltrexone. These medications help reduce people’s drug cravings and lower their risk of overdose, especially when paired with counseling. 

But only a fraction of people with opioid use disorder — in North Carolina and across the United States — receive the medications, which are widely considered the best way to address opioid addiction. Stigma has long been a barrier to treatment, but as people learn more about these medications, that’s slowly decreasing.

Getting to care has been an ongoing issue, though. Transportation barriers and a lack of providers has stymied people’s ability to get care, even when they want help. 

Another patient bikes about 15 to 20 minutes to the mobile unit. It isn’t his first time receiving medications for opioid use disorder, Evans said, but this time has been different.

“He’s been in and out of treatment for probably about three or four years, typically stays two to three weeks and disappears, comes back a month later, then in two to three weeks disappears — just really in and out,” Evans said. “He’s always had problems getting from Burlington [to Greensboro].”

Since the mobile unit has brought treatment closer to home, the man no longer has to worry about making the trip to Greensboro. As a result, Evans said he’s been more consistent with treatment than ever before.

The response to the unit has underscored the need in the community, Evans said. The mobile treatment program serves about 50 patients daily between its two stops — Bethel African Methodist Episcopal Church in Greensboro and the Alamance County Health Department — and those numbers are growing as word of mouth spreads. 

“I’ve watched this mobile unit actually change lives,” Evans said. 

New Season’s mobile clinic is one of North Carolina’s growing number of mobile treatment programs, part of an effort by state leaders and addiction treatment providers to make opioid use disorder treatment more accessible. The state’s third mobile unit, operated by SouthLight Healthcare, started serving patients at Oak City Cares, a hub that offers services to people at risk of or experiencing homelessness in Raleigh, on June 15. Five more are expected to start serving western North Carolina in the coming months, bringing addiction treatment to counties that have never had opioid treatment programs. Another mobile unit is in the works in Mecklenburg County. 

“My hope is that they’ll be able to reach people that otherwise couldn’t have reached treatment,” Anna Stanley, who oversees North Carolina’s programs that provide medications for opioid use disorder across the state, told NC Health News.

New access to treatment

North Carolina’s first mobile unit, operated by Morse Clinics, began serving patients in Raleigh last July. In less than a year, it has built a caseload of about 150 patients — even though Wake County has several brick-and-mortar clinic options. 

Eric Morse, chief medical officer at Morse Clinics, partnered with Healing Transitions, a Raleigh nonprofit that provides peer-based recovery services, to bring the mobile unit to its men’s and women’s campuses each day.

The unit’s presence has helped boost retention rates in Healing Transitions’ yearlong recovery program, Morse said. 

“Some of our first patients that we had in July are now graduates from Healing Transitions’ one-year program,” Morse said. “Those stand out as people who may not have — probably would not have — been able to in the past complete the program, if it weren’t for our presence.”

Before the mobile clinic arrived, more participants would return to drug use after a few weeks because cravings were so intense, he said. 

The unit also serves community members who are not enrolled in a Healing Transitions program but find the location convenient for accessing their medications.

The number of patients served by the mobile opioid treatment programs is growing. As of June 11, the two mobile units had an active census of 202 patients, according to N.C. Department of Health and Human Services data provided to NC Health News. Since January, the units have completed 483 admissions to treatment, administered 5,654 doses of medication and conducted 877 counseling sessions. 

“A lot of folks that are able to access the services via the mobile unit just wouldn’t have had the ability to do that at the brick-and-mortar,” Stanley said.

The mobile clinics have connected 84 people experiencing homelessness to medications for opioid use disorder, according to DHHS data. Reaching people experiencing homelessness in North Carolina is particularly important, as overdose has been the leading cause of death among the population in recent years.

SouthLight Healthcare, the state’s largest opioid treatment program providing medication to more than 900 patients, recognizes the need among this population. That’s part of why the organization chose Oak City Cares — a hub serving people experiencing homelessness — as the mobile unit’s first stop. They already have a handful of patients who take the bus from that location to their brick-and-mortar clinic.

“It’s probably an hour-and-a-half round trip for them to two-hour round trip for them just to come over for a very brief appointment with us,” Adam Hartzell, CEO of SouthLight Healthcare, said. “We also believe there’s a lot of unmet need there and that if it was easier, people would sign up for services.”

Kathy Johnson, executive director of Oak City Cares, which serves more than 6,000 people a year experiencing homelessness, said welcoming the mobile clinic on-site was an easy decision because transportation is one of the biggest barriers people face when trying to access services. 

“Sometimes just getting across town can be difficult and overwhelming and time-consuming and expensive,” Johnson said.

In the coming months, SouthLight also plans to take the mobile unit to Fuquay-Varina, an area without an opioid treatment program. 

Along with medical providers, SouthLight takes a peer support specialist along as part of its staffing. The role is especially important as the unit goes to locations where people may have less familiarity with medications for opioid use disorder and are deciding whether to start.

“They can say, ‘Hey, I’ve done it,’” Hartzell said. “Beginning treatment can be scary, and it’s not easy. [A peer is] somebody that’s already been through that change and can kind of say, ‘Hey, this is what it looks like on the other side, and this is why it’s worth it.’”

More units coming

Stanley, State Opioid Treatment Authority at NCDHHS, said six additional mobile units are expected to begin serving patients once they’re fully certified and licensed in the coming months.

Five are being funded by $3.75 million that NCDHHS received after Hurricane Helene and subsequently provided to Vaya Health, the regional behavioral health care organization that serves 32 mostly western North Carolina counties. The funding was awarded to treatment providers that agreed to deploy a unit to counties that had no treatment program — an intentional effort by state officials to reach new areas of need and get a program into all 100 counties.

Vance Recovery, a Morse Clinic in Henderson, will soon be operating a mobile unit to serve Granville and Franklin counties — which have not had an opioid treatment program. The unit plans to go to the Oxford Armory and Advance Community Health in Louisburg.

Morse knows that as he expands access to medications for opioid use disorder to new areas, he’ll also have to work on breaking down stigma. Despite extensive evidence of their effectiveness, some people continue to believe the medications simply “substitute one drug for another” and that abstinence-based recovery is the only path.

He’s already encountered some of that resistance while searching for a parking spot. 

“I literally walked around Oxford looking for a location and talking to businesses,” Morse said. “Everybody I talked to was like, ‘This is something that this community needs, but I do not want to host it.’” 

Morse knows there’s demand for treatment. He said he already has dozens of patients who travel to his Vance County clinic who will soon have a closer option. The mobile unit will also create a new treatment option for people who previously couldn’t make the logistics work.

Morse hopes the unit’s visibility in the community — and the outcomes of those served by it — will help reduce stigma and reach people who could benefit. 

“This treatment works,” Morse said. “The more we can make access to care easier and more efficient, the more likely people are going to survive and recover.”

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