NIH-Funded Study Tests Mobile Clinics as a Way to Treat Substance Abuse

In five major U.S. cities, researchers are exploring mobile health clinics as a possible solution to the continuously growing opioid epidemic.

In a new clinical trial, researchers will evaluate whether mobile health clinics help people with opioid use disorder treat their substance abuse and prevent or receive care for HIV/AIDS.

The mobile clinics will be placed in Los Angeles, New York, Houston, Philadelphia, and Washington, D.C., in residential areas where opioid use is more prevalent.

The trial comes as the Biden Administration doubles down on efforts to curb the opioid crisis. Just this week, the Drug Enforcement Administration finalized a rule that will make it easier for mobile vans to deliver methadone, an opioid addiction treatment.

Now, all licensed narcotic treatment programs can utilize these mobile units. Previously, mobile clinics had to be registered separately which kept some clinicians from practicing this care.

The study aims to enroll 860 participants across the five cities and will run for 26 weeks. It's sponsored by the HIV Prevention Trials Network and received funding from the National Institute of Allergy and Infectious Diseases and the National Institute on Drug Abuse.

Barriers to Getting Treatment

People with opioid use disorder face barriers when trying to access opioid use disorder treatment. Experts are hopeful mobile health clinics will work to remove some of them.

"Many individuals have poor access to transportation or struggle to meet other key needs like basic housing, food insecurity, and identification," S. Monty Ghosh, MBT, MSc, MD, a doctor of internal medicine and addiction medicine and assistant clinical professor at the University of Alberta, tells Verywell. "Bringing resources to them removes additional burdens they may face as the resources are right there for them to use."

Healthcare workers, police, and the justice system may also interfere when people try to access care. The National Academies of Sciences, Engineering, and Medicine says some of these obstacles include:

• Concerns about the misuse of medications like methadone also contribute to the insufficient numbers of providers willing to prescribe them.
• Treatment decisions for opioid use disorder often happen under the control of law enforcement and the judicial system.
• Medicaid, unlike some private insurance plans, does not cover medicine for the treatment of opioid use disorder in all states.

Why People With Opioid Use Disorder Are at Risk for Contracting HIV

In addition to unprotected sex, people who inject drugs may contract HIV/AIDS by sharing needles, syringes, and other drug injection equipment with someone who has the condition. According to the Centers for Disease Control and Prevention (CDC), sharing syringes is the second riskiest way to contract HIV.

In fact, around one in 10 recent HIV diagnoses in the United States are attributed, at least partially, to injection drug use.

"If they have HIV/AIDS, it can then be transferred to another person," Anton C. Bizzell, MD, a physician who advocates for addressing healthcare disparities and the chief executive order of the Bizzell Group, tells Verywell. "It's also important to know that we can decrease the incidence of substance abuse, as well as infections that can occur."

How Can Mobile Vans Help?

These mobile health units will aim to manage HIV infections and opioid use. The clinics will provide various kinds of care like:

• Medication for opioid-use disorder
• HIV testing
• HIV treatment for HIV-positive participants not already in care
• PrEP for HIV-negative participants
• Testing and referral for vaccination or treatment for hepatitis A virus (HAV) and hepatitis B virus (HBV)
• Testing and referral for treatment for hepatitis C virus (HCV)
• Sexually transmitted infection (STI) testing and treatment
• Primary care
• Harm reduction services
• Peer navigation, or the help of peer advocates
• COVID-19 testing and referral for further evaluation, care, and/or treatment

One of the medications available at these mobile health clinics is naloxone, an overdose reversal medication.

Both Ghosh and Bizzell believe that these clinics could help attract people who do not feel welcome in traditional medical settings, such as in a hospital or a place far from where they live.

"Many of these populations are highly stigmatized and feel unwanted by conventional health resources," Ghosh said. "Bringing resources to them shows the population you care, and that you are here to support them. "

Patient Advocates

Experts stress that one of the most important aspects of this clinical trial is the decision to include patient advocates.

In a healthcare setting, patient advocates are often people who have navigated the same or similar health challenges. Bizzell says these advocates can also play a role in encouraging people who inject drugs to seek treatment.

"Their peer advocate is going to make sure before they leave there that they have at least a place to live or place to stay, they will enter into a treatment program, and they will follow them through their recovery," Bizzell says.

They form a key part of community-based care and programs.

Location of Care

Bringing these mobile health clinics to residential areas can be cost-effective for people who want treatment for opioid use disorder and associated health problems like HIV/AIDS.

Bizzell also recommends placing mobile clinics near places of employment as an effective strategy.

"When you're taking the care directly to where they are, it saves the cost right there," Bizzell says. "Or even if you're taking it to their place of employment, then you don't have to worry about taking the time off from your job, you can go directly to them, or you don't have to have that transportation costs as well."