Transportation to Substance Use Disorder Treatment

Opioid addiction is a particularly insidious disease, one that is more recently leading to a spike in overdose deaths. Recent estimates place the 2020 national overdose death total at 93,331—an alarming 32% increase from 2019. As this study explained, “The increase in opioid overdose deaths (OODs) during the pandemic has been attributed to various factors: reduced access to interventions, increased levels of stress due to isolation and loss of mental health support, and changes in the types/combinations and purity of drugs and patterns of drug use.”

Transportation cannot curb access to highly potent, chemically manufactured drugs such as fentanyl; transportation cannot solve the social factors that might lead a person to use addictive drugs; and transportation cannot help increase the number of substance use treatment professionals or clinics available to addicted individuals, particularly in rural areas. What transportation can do is to provide a way for individuals experiencing addiction to get to the treatment options that do exist.

One of the most effective treatments for opioid addiction is “medication-assisted treatment” (MAT), which is the use of medications in combination with counseling and behavioral therapies. However, methadone can be dispensed only from Substance Abuse and Mental Health Services Administration (SAMHSA)–certified opioid treatment programs (OTPs), creating access barriers in rural counties with a shortage of facilities.

A recent study examined drive times to the nearest OTP in urban and rural counties in five states with the highest county rates of opioid-related overdose mortality. Of the 489 counties studied, the authors noted that the mean drive time to the nearest OTP was 37.3 minutes; the average drive time in the urban areas was 7.8 minutes versus 49.1 minutes in the rural areas. 

Over the past decade, NCMM has had the privilege of working with rural communities that are trying to ensure that transportation is there when needed, again. In 2018 NCMM worked with a community team in Shiawassee County, Michigan, to plan how to help addicted individuals in a prison-diversion program get to Corunna, the county seat, for their many required appointments. In the process of its work, NCMM and the team heard these insights from those involved in the diversion program:

• The weekly requirements for participants in the diversion program are onerous. For example, in the beginning stages of the program, they have a minimum of 11 appointments they must attend, including treatment, recovery support groups, court appointments, and randomly scheduled urinalysis tests to which they must respond within 3 hours. In addition, they need to be looking for work or going to school, and may also have small children to care for. Transportation in a rural area to all these destinations is extremely challenging, adding to the complications these individuals must deal with while in active recovery.
• As one participant noted, “The energy I should be spending on recovery is instead spent navigating the whole system, including transportation. I need outside help to coordinate everything.”
• Family dynamics and community support systems have a significant input on recovery, yet many individuals have burned these bridges and no longer have the support of their families. Sometimes their only hope for transportation is the local public transit system.
• Felons cannot give rides to other felons so drug court and probation participants cannot carpool.

The solution designed by the Shiawassee team was to create a drug court community hub in Corunna that would be 1) located close to all appointments, which were within one mile of each other; 2) provide a fleet of bikes for participants to use to get to those appointments; 3) have a team of volunteers on standby for rides to more complex appointments; and 4) provide supportive activities, such as computers and navigators to assist with resumes, employment applications, GED prep, etc., between appointments. The idea behind this solution was the rural transportation system could more easily group trips to this community hub, where individuals can hang out for an entire, productive day, rather than schedule multiple individual trips to appointment after appointment from anywhere within the county. [Note: Due to many factors, the team members were no longer able to commit to this solution and thus it was never implemented.]

In 2020, a remarkable example of coordination among all transit agencies in West Virginia was launched to ensure any individual seeking treatment could get the transportation connection they needed—regardless of where in the state they needed to go. This effort was funded through a State Opioid Response (SOR) grant from the Substance Abuse Mental Health Services Administration (SAMHSA). Watch this moving video of a driver working for the Eastern Panhandle Transit Authority (EPTA), which was one of the participating agencies.

A second project some NCMM staff, who also work at the Community Transportation Association of America, were involved in was implemented in 2021 with support from the Appalachian Regional Commission. Staff designed a video-based training for substance use clinic case managers in Huntington, WV, to inform them about local transportation options for their clinic patients. The video was important to ensure continuity of knowledge among all case workers and mobility managers in these clinics, where there is a high rate of staff turnover.

Now its 2023, and NCMM is once again helping a community with transportation to addiction treatment. The Upper Cumberland Human Resource Agency (UCHRA), a community action agency in the Upper Cumberland Region of Tennessee, received an NCMM Ready-to-Launch Pilot grant to expand its nascent Ride-to-Recovery Program. That service aims to help those who are in early recovery succeed by providing 90 days of transportation to desired recovery support services—treatment, meetings, mental health or probation appointments, and other recovery-related activities—at no cost to the participants.

NCMM’s grant will fund the next phase of this service, employing a State Certified Peer Recovery Specialist (CPRS) to staff a Ride-to-Recovery specific vehicle. A CPRS is a person who has lived experience and is trained on how to offer peer support and who also has a working knowledge of local recovery resources. As one of the leaders of the project noted, a person taking the first step to get help with their addiction is in a very precarious position, and not fully committed to the step they are about to take; on the way to their first treatment appointment, they are just as likely to change their mind and jump out of the vehicle at a stoplight. Having a CPRS driver, again someone with lived experience, can help in that dramatic moment to support their decision toward recovery. Through the development of relationships with participants of Ride-to-Recovery, the CPRS will be able to notice red flags of a possible relapse and intervene in a compassionate way to guide the participant to the appropriate help and resources. Stay tuned to learn the progress of the project in a future Mobility Lines post.