Date: October 2, 2023
By Chris Serres
‘It’s a godsend’: Mobile clinic provides life-saving relief to Worcester residents struggling with addiction
Hundreds of addicts have received treatment from the clinic on wheels, though regulatory obstacles remain.
On the edge of downtown Worcester, between a church and a busy transit station, dozens of people stood waiting in a soft morning rain for the doors of a white van to open.
Derrick Cormier took a final drag from his cigarette and stepped into the van with the upbeat demeanor of one entering a friend’s home. Within the van’s narrow walls, Cormier swallowed a faintly sour, pinkish liquid from a small plastic cup. The daily dose of methadone helps keep Cormier, 50, a self-described addict and former warehouse worker, from smoking fentanyl, a highly potent synthetic opioid that has brought him to the brink of death four times in the past year.
“I can’t put into words how much this has helped me,” said Cormier, who fell into drug abuse four years ago to cope with the trauma of the death of his infant son. “If not for this van, I’d be out there on the streets chasing my next high. Most likely, I’d be dead by now.”
Since it opened in February, this 32-foot clinic on wheels has become a vital lifeline for hundreds of Worcester residents struggling with addiction and a daily reminder of the breadth of an opioid crisis that continues to exact a deadly toll across New England. In Massachusetts, fatal opioid overdoses last year reached their highest level on record, with more than 2,300 lives lost. The state’s rate of deadly overdoses, measured as a percentage of the population, is now nearly one third higher than the national average.
Those who enter the clinic’s doors each morning come from all walks of life — local factory workers, artists, students, and the homeless — all bound by a common quest to avoid excruciating withdrawal symptoms and a desire to get their lives on track.
The retrofitted R.V. is one of three mobile opioid treatment clinics in the state, but the only one that offers all three of the drugs approved by the Food and Drug Administration to treat opioid use disorder. These include methadone and buprenorphine, which bind to the brain’s opioid receptors long enough to prevent cravings or symptoms of withdrawal. Buprenorphine, often marketed under the name Suboxone, and the third medication, Vivitrol, are important alternatives, treatment specialists say, because they are considered safer than methadone and satisfy cravings without providing a high.
“This is a huge step forward,” said Dr. Mark Albanese, an assistant professor of psychiatry at Harvard Medical School who oversees treatment services for the Cambridge Health Alliance. “By going into the community, this [clinic] eases the burden of people getting the help they need and demonstrates that you don’t need a brick-and-mortar clinic to get people life-saving treatment.”
Notably, 70 percent of the more than 400 people who have begun an addiction medication program through the mobile clinic have stuck with the regimen, and keep returning day after day for their medications, according to Spectrum Health Systems, Inc., a nonprofit treatment provider in Central Massachusetts that operates the clinic.
The two other mobile clinics in Massachusetts are in Quincy and Wellfleet. The state also has more than 50 brick-and-mortar clinics for treating opioid abuse, which offer methadone, buprenorphine, and other craving-reduction drugs. But access can be challenging. Many have narrow time windows for dispensing drugs, only admit patients on certain days, and charge co-payments that can strain people’s budgets, say treatment specialists.
“Sadly, we have built a gauntlet of barriers for people to get essential medicine that will keep them alive,” said Traci Green, director of the Opioid Policy Research Collaborative at Brandeis University.
Beyond those challenges, a combination of regulatory burdens on opioid medications, neighborhood opposition, and persistent stigma have long stood in the way of mobile treatment clinics like Spectrum Health’s. Only in 2021, as the overdose crisis entered its third decade, did the federal Drug Enforcement Administration (DEA) ease rules allowing for mobile methadone treatment programs.
Still, the medications offered at the clinic in Worcester are seen as a vital step toward weaning patients off opioids, and are most effective when they are combined with one-on-one counseling and therapy. Unlike many drugs, opioids like heroin and fentanyl have the ability to change the brain’s chemistry, which means counseling and abstinence alone are less likely to be effective than a recovery plan that incorporates sustained treatment with medication, say addiction specialists.
Even with the opioid medications, people can still have cravings and suffer occasional relapses. Some people take methadone for years while working and living productive lives.
In Worcester, a city experiencing one of the state’s highest overdose rates, organizers of the mobile clinic still faced significant obstacles.
It took two years for Spectrum Health to get regulatory approvals and to retrofit a recreational vehicle to dispense the medications. Providers also discovered that their life-saving treatment wasn’t welcome everywhere. Authorities with the Worcester Public Library, where many homeless addicts congregate, refused to allow the van to park outside its downtown facility, saying it already hosts large numbers of visitors who are homeless and who struggle with substance use and mental health disorders.
“This is a statewide crisis, not an isolated library issue,” said Jason Homer, the library’s executive director, who added in a statement that the library continues to provide outreach services and recently created a new social worker position to help more people.
The local Walmart store has yet to make a formal decision on a similar request, providers said. For now, the roving van is limited to a few stops, including a parking lot at St. John’s Catholic Church and a homeless shelter.
Yet for many the arrival of the mobile van has been life-changing.
Each day, more than 100 men and women in various stages of addiction and recovery visit the mobile unit at its few morning stops on Worcester streets. The van is small enough to squeeze through rush-hour traffic yet big enough to staff a bevy of specialists, including a nurse, recovery coach, and a social worker who can connect patients with housing and mental health services. “The goal is to stabilize people by going directly to those places where they feel most comfortable,” said Dr. Matilde “Mattie” Castiel, Worcester’s commissioner of health and human services.
For years, Amanda Hebert, who lives in a tent in a wooded area near the local Walmart, had to wake at dawn and take two buses to receive methadone at a stand-alone clinic. The trip took nearly three hours round-trip and was nearly impossible on mornings when she was suffering from withdrawal symptoms, including pain so agonizing that “it felt like my spine was being pulled from my back.”
On days Hebert missed her dose, she would seek relief from fentanyl, a fast-acting drug that is many times more potent than heroin and last year was involved in 93 percent of fatal opioid overdoses in Massachusetts.
Now, Hebert only has to catch a single bus each morning to St. John’s Catholic Church on Temple Street, where she can grab breakfast at the food pantry before getting her 60-milligram dose of methadone at the mobile van. The methadone doesn’t eliminate her cravings, but it eases them long enough that she can attend regular therapy for her addiction and look for housing.
The daily doses also have helped Hebert avoid the life-threatening substances infiltrating the illicit drug supply. This spring, she was hospitalized with sepsis, a dangerous blood infection, after she injected fentanyl laced with the veterinary sedative xylazine, also known as “tranq.” In tests of opioid samples, xylazine has been found in about a third of New England’s illicit drug supply, and is particularly dangerous because it prolongs highs and is resistant to overdose-reversal drugs such as Narcan. Xylazine also causes deep flesh wounds resembling burns that can become infected and even lead to amputation.
“It’s a godsend,” said Hebert, 31, after receiving her methadone dose. “It’s the difference between feeling like you want to die every day and beginning to find a way to live a normal life.”
Outside the clinic, Cormier pulled up his shirt to reveal deep pink and purple scars from xylazine on his elbows and torso. The scars are a reminder of why he keeps returning to the same church parking lot for methadone, promptly at 8 a.m., for the past eight weeks. A counselor at the clinic helped enroll him in a therapy program. “Now I’m chasing my recovery as hard as I once chased my addiction,” he said.
Nearby, Steven Cox kept a close eye on the scores of homeless people who pour into the St. John’s Catholic Church food pantry where he volunteers. Fentanyl overdoses have been so common at the site that Cox, who is 68 and is a recovering cocaine addict, keeps several doses of Narcan in his front pocket. He makes rounds of the facility’s bathroom and parking lot to check for anyone passed out from fentanyl use. It used to take a single Narcan dose to revive people; now, he says it takes three to four doses.
“This poison is ripping people apart,” he said.
At every opportunity, Cox has been gently urging those with signs of addiction — including those with visible wounds from taking xylazine-laced fentanyl — to visit the mobile methadone clinic next door. Within weeks, he said, those who begin the treatment look transformed.
“Without the methadone, a lot of these people would barely be surviving,” he said. “And that’s no way to live.”