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Wheels Matter on the Road to Recovery

June 10, 2019

What prevents people struggling with substance abuse from undergoing treatment? Start counting the ways. We interrupt this exercise to offer a reason that may not be top of mind. One word sums it up: transportation. Having a means of getting to treatment makes a difference.

How important is it? An article in Modern Healthcare explains. This piece starts with a one-sentence paragraph: “Transportation is the largest barrier for people seeking and receiving addiction treatment.” In other words, lack of transportation can be a deal breaker.

Let’s qualify the term “transportation” and various facets of it. Cost alone does not matter. Convenience and availability and count. What’s more, it’s not a one-off occurrence, but rather as often as needed. And ideally, it’s door-to-door in format. All told, transportation to receive ongoing substance abuse treatment services, is more than a means of getting there. Those in treatment must be able to access it easily, reliably and repeatedly.

Uber It

Early findings of a pilot program at St. Vincent Charity Medical Center in Cleveland support these points. The study set out to gauge the role of transportation in clients’ participation at its Intensive Outpatient Program (IOP) for substance abuse. Would providing it boost attendance?

Let’s use Uber for this study, they thought, to make a determination. With that in mind, the facility sent an Uber free of charge to the homes of those seeking an assessment and in treatment. The driver pulled up directly in front of a client’s address and took them to and from their appointments. To put this plan in place, the Center partnered with Circulation, a firm with a proprietary, HIPAA-compliant digital platform that links Uber with patients and health care providers.

“Intensive” is a key word in the treatment regimen. Clients must visit the facility frequently and on a set schedule for several months. For this IOP, they attend four three-hour sessions per week for the first five weeks of treatment; there also are one-on-one sessions with a counselor. The regimen then tapers for the following eight to 12 weeks to weekly one-and-a-half hour sessions in the next standard outpatient program (OP) phase.

That’s a lot of travel. During the first 30 days of the 90-day pilot, Uber gave the 11 IOP clients a total of 156 rides. How was attendance? 100%. Clients went to all IOP and individual counseling sessions.

Statistics were lower before. Without Uber, clients went to the IOP 76% of the time and individual counseling 62%. Prior to the pilot, the facility offered bus passes on a grant-funded basis and single-ride cab vouchers, mainly to take clients from detox to their next step in their care plan. On average, 62% of clients completed the five-month program. And the reason they cited most often for dropping out? “Lack of access to affordable, reliable, convenient transportation.”

Rural and Inner City Dilemmas and Responses

Rural areas have a double whammy. They are hard hit by the opioid crisis and often lack public transportation systems. This compounds the difficulty for clients who may want or need to use this means to get to treatment. In light of this problem, the Appalachian Regional Commission is seeking solutions. The experiences shared by three men in West Virginia underscore this issue. Although it wasn’t easy, they managed to find rides to access services, even if they had to pay for it themselves. The outcome is good – they all are in recovery. And they acknowledge that having reliable rides was “the deciding factor.”

Also besieged by the opioid epidemic, Baltimore is deploying transportation; however, it is using it in another way. Instead of clients going to a formal treatment facility, a mobile van comes to a location near them. However, that’s unless this white GMC truck breaks down, as it did recently. That’s when doctors and nurses used their own cars to see clients.

In service since November 2017, the van usually works. It stops in easily accessible spots, such as in front of the city jail, four mornings each week. Operated by the Behavioral Health Leadership Institute and funded by private foundations, the fully equipped van is a facility on wheels. Clients don’t need appointments or any form of identification or insurance. The idea is to get people into treatment. And it works.

This is but a glimpse into one of the main challenges in treating opioid addiction, likely an unexpected one. Understanding the importance of convenient transportation is important for  institutions. It bears the same status for clients. Awareness on both ends is the first step. Effective solutions come next.

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Read More from Sherry M. Adler:

Purdue Pharma and the Sackler Family Fall from Grace

Attention: ADHD Drugs Spike – Is an Addiction Crisis Far Off?

The Roots of the Opioid Epidemic

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