Date November 21, 2023

The Road to Recovery

Dr. Francesca Beaudoin was the first physician in the nation to serve patients in a mobile drug recovery unit. The van, an innovative public health intervention on wheels, delivers services to individuals suffering from substance use disorder in Rhode Island’s underserved communities.

Photos by Kenneth C. Zirkel

Dr. Francesca Beaudoin has been on the frontlines of the opioid crisis for most of her career. She saw its impacts early on during her residency as an ER doctor in the mid-2000s when opioid prescribing was at its peak. Opioids were everywhere, she says. “I was watching people come into the emergency room both trying to obtain opioid medications for an underlying opioid use disorder, but also people with ill-treated pain,”

But no one saw the crisis that was coming. “We didn't see the lights on the train in the tunnel at that time,” she said.

By 2010, the epidemic was transitioning from prescription opioids to illicit opioids, fentanyl, and analogues and in response to what she saw everyday in the emergency room, Beaudoin shifted her focus from pain management to the opioid crisis.

For the past year, Beaudoin, professor and chair of the Department of Epidemiology, professor of emergency medicine and interim academic dean of the School of Public Health, has spent a part of each week caring for those affected by that crisis. But she doesn’t see patients with opioid use disorder at a hospital or in a traditional clinic setting. Instead, Beaudoin travels to Woonsocket, Rhode Island where a mobile recovery van run by CODAC Behavioral Healthcare serves patients on a busy, well-trafficked street near a bus stop.

The 27-foot-long RV looks like an everyday camper, painted in shades of teal and displaying the CODAC logo. But inside, there's a counseling room that can fit in four, a bench for people to wait, a bathroom, a desk, a security system, a refrigerator stocked with snacks and an area for dispensing medications, like methadone.

The idea is pretty simple: provide medication assisted treatment, without the barriers or stigmas that often come with going to a clinic, in a flexible setting within the communities where people need it.

“We know that the proportion of methadone clinics that are in the community do not meet the needs of the patients,” Beaudoin said. “Particularly when those patients don’t have housing or transportation.”

CODAC’s mobile unit, the first of its kind in the United States, is able to flexibly visit the state’s hot spots staffed by physicians like Beaudoin, nurses and peer recovery coaches who connect patients with insurance and help with housing, food, and employment services.

It took time for the recovery van to find its footing. At first, Beaudoin said, “we spent a lot of time outside actually just talking to anybody that would come by to call attention.”

Eventually, word got out and people came. The van now has a census of over 60 patients engaging with the unit. 

Other bumps in the road have come from opposition from the City of Woonsocket. “It's this whole ‘not in my neighborhood’ thing that people don't want methadone clinics and opioid treatment programs near them,” Beaudoin said. The city even served the program a cease and desist order, arguing the R.V. violates zoning laws. But the unit never left.

“Things are moving in a positive direction,” Beaudoin said. “I have had conversations with Mayor Baldelli-Hunt of Woonsocket, and she is an advocate for patients suffering from opioid use disorders and sees the crisis in her city. So I think there is a commitment there to help solve this problem and recognition that the mobile unit is one way to do that.”

“ We know that the proportion of methadone clinics that are in the community do not meet the needs of the patients. Particularly when those patients don’t have housing or transportation. ”

Francesca Beaudoin M.D., Ph.D.’17 Professor of epidemiology and of emergency medicine, chair of Department of Epidemiology, interim academic dean of School of Public Health

A Data-driven Approach

A methadone dispensary on wheels sounds like a good idea: By driving into communities, targeting those in need, a mobile health van provides a flexible access point for recovery. But in order for this good idea to literally gain traction and spread beyond Rhode Island, policy makers will need evidence, not only of its effectiveness, but of the likely impacts to multiple stakeholders.

To test CODAC’s mobile unit, the behavioral healthcare organization is partnering with the School of Public Health on a one-year, NIDA-funded study. Using quantitative and qualitative approaches, Brown investigators will assess the experiences of the mobile unit's patients and staff to identify barriers and facilitators to treatment. They will also compare these patients and their health outcomes to patients served by CODAC’s traditional brick-and-mortar treatment facilities.

By working directly with community organizations like CODAC, study co-PI Rosemarie Martin Ph.D. says, we can “ensure our research is directly relevant to practice and policy.” The associate professor of behavioral and social sciences, who studies pharmacologic interventions for substance use disorders, says that community collaboration is essential. “Our research would not be nearly as robust or impactful without the critical contributions of community partnerships. Research with partners, like this project with CODAC, has played an instrumental role in turning the tide of national and worldwide opinion about the use of medications for opioid use disorder.”

“ Our research would not be nearly as robust or impactful without the critical contributions of community partnerships. ”

Rosemarie Martin Ph.D. Associate professor of behavioral and social sciences