Methadone has been used for decades to treat opioid addiction. It is also difficult to come by, a problem health providers hope to ease with a new fleet of vans that can provide the drug.
By Sharon Otterman
Before he started taking methadone, Vinny Parisi had overdosed 16 times from using street drugs, including fentanyl. Eating out of garbage cans and sleeping under a bridge in Harlem, he finally hit bottom, he said.
Now, Mr. Parisi goes every weekday morning to an R.V.-size white van parked at a Days Inn in the South Bronx. Within a few minutes, he drinks a bright pink fluid — a dose of methadone — saving him the hours of commuting and waiting it often takes to visit a brick-and-mortar clinic to get the drug.
“This definitely works, I’m living proof,” Mr. Parisi said on a recent Tuesday outside the van, where he was waiting with about a dozen other men from his residential drug treatment program. He is only 30 years old, but has been in and out of treatment programs since age 15, after starting to abuse pain pills on Staten Island.
“My mother sent me a picture of me and 12 friends, and I’m the only one left alive,” he said.
Mr. Parisi is one of an estimated 450,000 Americans who take methadone, a powerful weapon in the fight against the fentanyl overdose crisis hiding in plain sight. Methadone, itself a potent opioid, has been used for decades to treat people addicted to drugs like heroin. But it can also be hard to come by, because of government rules that have kept its distribution tightly controlled.
As America’s deadly overdose crisis has worsened, however, some of those rules are loosening. Now, some public health experts hope that mobile treatment programs, like the one in the Bronx, will help increase access.
Addiction experts say methadone is particularly important as the strength of street fentanyl has raised the opioid tolerance levels of some users so high that other medications and approaches don’t always work.
“Methadone is this extremely effective medication,” said Noa Krawczyk, an expert in opioid use disorder treatments at the New York University Grossman School of Medicine. “It has saved thousands, and probably millions of people’s lives around the world. And yet in the U.S., it’s extremely difficult to get.”
The vans were approved by the federal government in 2021, lifting a moratorium on their use that had been in place since 2007. Their goal is to reach some of the millions of Americans struggling with opioid addiction that the nation’s roughly 2,000 methadone clinics cannot.
While other addiction treatments can be prescribed by doctors and picked up at pharmacies, methadone can only be distributed at special clinics that impose strict rules on recipients, and now at vans affiliated with those clinics. For those receiving treatment at a clinic, patients often have to stop by six days a week and receive regular drug tests and counseling.
The regulations were designed to limit the chance that methadone would be sold on the street or misused, which could cause overdoses. Methadone is much less potent than fentanyl, but has street value, often among those who want to self-medicate to stave off opioid withdrawal symptoms.
A growing number of studies, however, have shown that the drug’s risks are significantly outweighed by its benefits, especially now that street opioids are so dangerous.
“There’s no reason why methadone can only be prescribed and dispensed in an opiate treatment program,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.
An estimated 107,500 people died of a drug overdose in the United States in 2023, about 74,700 of them after ingesting fentanyl. This was a slight decrease from the previous year, when about 76,200 people died of fentanyl overdoses, nearly 5,000 of them in New York State, according to the latest data available.
Still, the vans are not a panacea.
While they make treatment more accessible, Dr. Volkow said, the cost and ongoing restrictions limit the number of people that they can help.
Constructing and outfitting a methadone van costs about $375,000, according to the New York organizations that run them. The vans have to replicate the high-security environment of clinics, with a security guard, 360-degree cameras and a safe for the medication.
“We have to think through how sustainable such costs are,” Dr. Volkow said.
There are now 42 vans registered nationally, though not all are operational yet, said Linda Hurley, a board member of the American Association for the Treatment of Opioid Dependence and the director of an organization that runs a methadone van inRhode Island. In New York, state officials have approved 11 vans, but so far, only two are on the road, both in New York City, said Dr. Chinazo Cunningham, the state’s commissioner of the Office of Addiction Services and Supports.
“This is new, so we don’t know, but we’re hopeful that it will improve access and we’ll reach people that wouldn’t ordinarily be reached,” Dr. Cunningham said.
Nearly half of New York’s 62 counties have no opioid treatment sites, according to a recent analysis. The programs that do exist are often concentrated in the city.
But so far, the reach of the New York methadone vans are limited. Since it starting operating last December, the van in the Bronx has had only 63 different patients.
The vehicle is run by Acacia Network, a social services provider. For now it has just one stop, a parking lot at a Days Inn that serves as a men’s homeless shelter, where it treats about 25 to 30 people a day.
The organization is planning to add a second stop in the Bronx soon, likely near a busy hub at Third Avenue and 149th Street where open drug use is common. But finding a place to park there that is both accepted by neighbors and provides some privacy for patients is taking time. In addition, Acacia wanted to start slow, to “iron out any kinks,” said Dr. David C. Collymore, the organization’s chief medical officer.
An initial start-up grant of $550,000 from the state for that van will likely soon need supplementing, he said. Acacia is also outfitting vans that will roll out in Brooklyn, Albany, Buffalo and Dunkirk, a city southwest of Buffalo.
The other van working in New York City is run by VIP Community Services. It pulls up once or twice each week in front of three residential treatment facilities — in Harlem, Wards Island and Long Island City — and treats about 90 patients per week, the organization said.
Some in the field of addiction medicine want methadone to be available at local pharmacies. Others, however, say the counseling and connection to other services that a van or clinic can provide is essential, since patients often have other medical needs and methadone can be dangerous.
For those who do use the vans, it can be life changing. “I don’t worry about dying no more for one thing,” said Kevin Ratliff, 60, as he waited outside for his dose in the Bronx.
“It feels good to wake up and not have to worry about getting medicated the other way,” he added, “because, you know, I died a couple times from them street drugs.”
Sharon Otterman is a Times reporter covering higher education, public health and other issues facing New York City. More about Sharon Otterman
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