Influx of mobile methadone clinics brings treatment to the streets – The Mercury News

By Anna Patrick, The Seattle Times (TNS)

There’s a small line forming outside a plain white box truck in Seattle’s Belltown neighborhood. A half-dozen folks are waiting on a gusty October morning for their turn to go inside and receive red liquid in a cup, medication that will help them get through the next 24 hours without opioids.

Or if they do use, to keep them alive.

It’s life-changing for some, this treatment program on wheels, and it has faced obstacles in the past, but fentanyl’s grip on Washington has given methadone distribution more urgency.

Taking the drug regularly is one of the most effective ways to satisfy someone’s craving for opioids without the high, and it has decades of research to show it can help people stay alive and clean. But federal regulations have largely required someone to travel to a building every day — an obstacle for people without access to reliable transportation or who struggle to stay organized.

This truck in Belltown reaches that population — mostly people who are homeless or low-income. They are also some of the most disproportionately affected by fentanyl — people experiencing homelessness made up more than 23% of King County’s total fatal overdoses last year despite making up less than 1% of the total population, according to this year’s Point-In-Time Count. The vast majority of those were related to fentanyl, according to King County Medical Examiner data.

To bring methadone to this population, the federal government needed to lower barriers for treatment providers, and local investments helped put more trucks on the street. Washington now has 11 units that are either deployed or in the process of being certified.

They are in demand. The Belltown truck, one of three operated by Evergreen Treatment Services, serves 172 patients and, since August, has served 48 patients in Pioneer Square. Evergreen is currently working to launch a fourth.

“We’re trying to be equivalent to a neighborhood pharmacy,” said Sean Soth, director of health integration and innovation for Evergreen.

We Care Daily Clinics’ three mobile units have seen similar, fast growth.

Dr. Tom Hutch, medical director of We Care Daily, said the majority of its mobile unit patients, who are primarily using methadone, come to them after other opioid treatment drugs didn’t work for them.

“A lot of the patients that we’re seeing have the most severe” opioid use disorder, Hutch said.

For Christina Bynum, 54, the Belltown mobile clinic is the difference between getting out of her apartment in the morning or letting her depression win.

After receiving her dose Monday morning, she was headed to a doctor’s appointment, something she would have never kept in the past, she said.

“It gets me out of my house to be here,” she said. “And it keeps me off of drugs.”

A strict past

Methadone has been around for more than 50 years, and federal research shows it reduces fatal overdoses by up to 60%, as well as reducing use of illegal opioids and positively affecting crime stats.

Methadone is a full opioid, which means it will satisfy someone’s craving, but if administered at too high a dose, it could make some feel euphoric or cause someone to overdose, explained Dr. David Sapienza, who oversees Public Health — Seattle & King County’s low-barrier buprenorphine clinic.

The possible dangers combined with “war on drugs”-era views on substance use disorder led to strict controls. So people had to report to brick-and-mortar locations every day to take their doses. Getting medication to take home was arduous.