BALTIMORE – The latest disaster in Baltimore's deadly and worsening opioid epidemic was a small one: The addiction treatment of, now 13 years old, wouldn't start.
The white GMC truck, open four mornings a week and parked outside the city jail, is an attempt to close a gap in the city's struggling addiction treatment system. But as the breakdown showed, even the attempts to plug holes in the system sometimes themselves have holes. With the out of service, doctors and nurses took their own cars to see patients already skeptical about getting treatment.
The cramped van, funded by private foundations and run by the Behavioral Health Leadership Institute, has a narrow hallway, a small kitchen, and two offices so small I could stretch my arms. It was back up and running by the time I visited, offering buprenorphine, one of the two medications considered the gold standard for opioid addiction treatment, two patients.
Since November 2017, clients have been able to walk in, unscheduled and get started on treatment. The van does not require ID – a big barrier, especially for people experiencing homelessness – or any kind of insurance. The main goal is to get someone into care, and then connect them to longer-term treatment in the more traditional health care system.
The van changed Michael Rice's life. Without it, "I'm still getting high," Rice, 58, told me, laughing nervously. He said that after 15 years of using heroin – a $ 1,000-a week habit, he said – he "got sick and tired of being sick and tired." Since he came to the van a year ago, he's been in recovery. 19659011] Michael Rice, 58, has been receiving opioid addiction treatment from the buprenorphine for nearly a year. If it wasn't for the program, Rice said, “I'm still getting high.” ” style=”object-position: 50% 49%” data-upload-width=”5624″ src=”https://cdn.vox-cdn.com/thumbor/LqGoYJvIRm88yHuX6GZtgpNOio4=/0x0:5624×3749/1200×0/filters:focal(0x0:5624×3749):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/15970468/BaltimoreOpioids01.jpg”/>
Michael Rice, 58, has been receiving opioid addiction treatment from the buprenorphine for nearly a year. If it wasn't for the program, he said, "I'm still getting high." Gabriella Demczuk for Vox
"This program works," he said. “I feel good. I keep money in my pocket. ”He pulled out dollar bills to prove it
. Treatment gaps exist all across the US. But Baltimore's gaps have been amplified by huge economic and health care disparities, leaving treatment inaccessible to the city's poor and, often, black residents – as overdose deaths climb to record highs.
"We need more of this," Rice said, pointing to the van.
For the past two decades, the news media has generally focused on white victims of the opioid epidemic in suburban and rural areas, such as in West Virginia and New Hampshire. And it's true that during the early years of the crisis, beginning with opioid painkillers, white people were the primary victims. But the crisis has widened to include illicit drugs like heroin and fentanyl, and black and urban communities are getting harder and harder.  In 2011, the national death rate for black people was 8.3 per 100,000, compared to 14.9 per 100,000 for white people. By 2017, the black overdose death rate had more than doubled – to 19.8 per 100,000. The white overdose death rate had climbed to 24 per 100,000.