WELLFLEET — The first-ever mobile methadone clinic on Cape Cod opened its doors here on Nov. 16 after a four-month-long process of getting licensing and approvals from federal and state agencies.
The van’s staff also put some time into learning to maneuver in the small parking lot and the smaller-than-usual clinical space, said Matt Davis, regional vice president of Acadia Healthcare, which runs the clinic.
The clinic operates in a 23-foot van in the parking lot behind the Outer Cape Health Services (OCHS) pharmacy on Route 6. Acadia also has a brick-and-mortar comprehensive treatment center in Yarmouth. Every day, the van comes from Yarmouth to Wellfleet, where from 6 to 9 a.m. it administers methadone to patients with opioid use disorder (OUD).
Before the mobile clinic rolled into Wellfleet, the closest clinic that offered methadone was Acadia’s in Yarmouth. Methadone, which is a long-acting opioid agonist, is administered daily to reduce opioid craving and withdrawal. It’s the medication that makes the most sense for those addicted to fentanyl, now the most common opioid. Those on the Outer Cape seeking medication-assisted treatment had to drive an hour there and back every day to continue recovery.
That proved to be an insurmountable obstacle for many, said Martha Gordon, who runs a recovery support group in Wellfleet. “A lot of people who are recovering don’t have licenses or don’t have cars,” Gordon said. “It was very difficult for them to get there using the transportation system we have out here.”
“It’s all about access,” Davis said of the new van. “There were people who couldn’t fit it into their lives because it was too far away. Now they can access treatment.” In rural communities, mobile methadone vans are often the only chance for recovery, said Davis.
The only other mobile methadone clinic in the state is in Quincy, also run by Acadia. It has been operating since the late ’80s, Davis said.
The van is currently treating 24 patients, Davis said. Appointments are currently walk-in only. But Davis said that could change as the number of people seeking care here grows.
“If we find that there are any issues in terms of traffic or flow, we’ll assign times,” he said. “But right now, there is not the need.” Davis says he expects the number of patients to stabilize at 150 as the word about the mobile van gets out.
Even then, Davis said, he does not foresee problems with overflow. “Ultimately, we will have patients who don’t come every day, who have progressed in treatment and will receive take-home medication,” he said.
Here is how the process works: patients pull into the parking lot — which was expanded to accommodate the clinic — and wait in their cars until they are called in by security personnel. There are usually two staff members present: the security staff member and a nurse practitioner or physician.
Each appointment typically takes no more than five minutes, during which the patient is administered a liquid form of methadone. Davis said that electronic medical records and other security measures are put in place to ensure that each dose is given to the right patient.
New patients receive a full medical assessment and psychosocial assessment. Each patient’s optimized treatment plan is different, said Davis. And patients’ need for methadone usually changes as they progress. “Some people may be on it for a year, some maybe for two years, and some may need to be on the medication for life,” he said.
The medication is most effective when it is paired with a holistic treatment plan, said Davis. “It’s a balance between assessing the medication and getting them to where they need to be with their other needs,” he said.
Acadia offers a range of recovery services via telehealth and in person at the Yarmouth clinic. Medication as well as counseling is covered by Medicaid and Medicare, said Larry Larsen, a spokesperson for Acadia, but “no one is refused treatment for inability to pay.”
The clinic has been collaborating with OCHS for referrals of patients, said Outer Cape’s Director of Behavioral Health Meara Baldwin.
“We are really excited to collaborate with them,” Baldwin said. OCHS offers office-based addiction treatment and an intensive outpatient addiction program known as SOAP, with group and individual counseling. “When patients are able to put together a menu of services that works for them, that really increases the odds that they will be successful in their recovery,” Baldwin said.
The van has a giant phone number inscribed on the side (877-272-1498), which is how many patients make the first call, said Davis. But Acadia also has other methods of outreach. A community liaison for the company visits medical facilities, police, and fire stations to hand out pamphlets. The clinic has published a help-a-buddy flyer patients can hand to friends who may need access to care.
Getting the van up and running has been no small feat. After receiving approval of a special permit from the zoning board of appeals on Aug. 11, Acadia had to apply to the state Dept. of Public Health for a license as well as an amendment to the license they hold for their Yarmouth location to include the mobile clinic. Then they had to get approval from the state Drug Control Program and the federal Drug Enforcement Agency (DEA), which visited the site to approve the van, the company’s policies, and security measures. Once the DEA sent its approval back to the Dept. of Public Health, the license was issued. The final step was getting a certification from the Substance Abuse and Mental Health Services Administration (SAMHSA) to operate the clinic. Davis said the clinic will become accredited within the next year.
Martha Gordon said having the mobile clinic here matters. One person she knows has long had trouble getting his medication, “so I know this is going to have a huge impact on him,” Gordon said.
The methadone clinic will offer a safe, supervised way for patients to taper, which can be lifesaving for those looking to go through detoxification, Gordon said.
At the local permitting hearing in August, the few objections expressed had to do with concerns that the van would create traffic and parking problems.
Dr. John Kelley, who owns the veterinary hospital next door to the pharmacy, was among those worried that the van might clog up the strip mall’s parking lot. Since the clinic opened its doors, however, he’s changed his mind.
“All the worries I had were unfounded,” he told the Independent. “It’s not a problem, and I don’t think it will be.”
“This was needed for so long,” Davis said. “The patients benefit and the community benefits. The feeling of a child in school whose parents are able to show up because they’re not driving two hours every day — it’s significant.”