With the COVID-19 pandemic making it harder for many individuals with substance use disorder to access care, the MetroHealth System in Cleveland is bringing resources to those individuals where they are.
As part of its Project DAWN (Deaths Avoided with Naloxone) initiative, which launched in 2013, MetroHealth has outfitted an RV with supplies it can now distribute at locations across Cuyahoga County. In addition to naloxone, the RV serves as a needle exchange, provides facemasks and other resources, and helps at-risk individuals—many of whom are unhoused or don’t have a regular doctor—connect with treatment.
Joan Papp, MD, FACEP, director of MetroHealth’s Office for Opioid Safety, tells Addiction Professional that the hospital system had long been interested in providing services to patients in a low-threshold setting, and while had plans had started to be formulated, progress was slow because of a lack of funding or definitive timetable. That changed at the outset of the COVID-19 pandemic, as walk-in sites where MetroHealth had been distributing naloxone off-campus were unable to continue operating because of a lack of PPE and other COVID-preventative measures.
Papp credits Stephanie Shorts, a chemical dependency coordinator with MetroHealth, for leading the charge to pursue other naloxone distribution options.
“Stephanie was so motivated,” Papp says. “She brought up a plan to distribute naloxone. … We approached our leadership team and said we wanted to do the RV for a long time. We knew there was an RV available from Medicaid enrollment that wasn’t not being used. We initially planned on using it for low-threshold access to care. Could we use it for Project DAWN? They said sure.”
Thanks in large part to the launch of the RV, Project DAWN distributed a total of 5,554 naloxone kits in 2020, with 2,600 being distributed through the RV alone.
“We have given out more kits this year than any other year, which is crazy because most of our sites were closed and several of them still aren’t operating,” Shorts says. “Some years we would do 2,600 for all the sites combined.”
In the early months of the pandemic, Shorts noticed that while patients appreciated having a way to access naloxone, they still sought clean needles because their usual syringe exchange location was closed. Recognizing the potential for an HIV and/or hepatitis C outbreak, the Project DAWN coordinators received approval from MetroHealth executive leadership to add syringe exchange services in the RV.
Project DAWN has also partnered with the Greater Cleveland Food Bank to distribute fresh produce and premade meals, and MetroHealth staff and other community organizations have donated blankets, coats and other supplies.
“We can also provide clients with resources for detox, treatment and other food banks,” Shorts says. “It’s nice to have those resources on the RV with us so that we can hand them to them right when they are getting everything. We can provide resources, a coat, fruit and clean needles. Clients can get everything all in one place. It makes things easier when times are tough for everybody.”
Papp says the team has learned two lessons along the way: While nice to have, a large RV isn’t necessary for the remote distribution of naloxone and needles and provision of services. In fact, MetroHealth is currently exploring the potential to add one or two smaller vehicles that can expand access to more locations in Northeast Ohio. Second, partnerships with local government and community organizations are great to have, but ultimately “you need to just do it,” she says.
“If you wait around until everything is perfect and all your pieces are in place, it’s not going to get done,” Papp says. “There’s nothing wrong with expanding as you go along, but you need to take the bull by the horns and do it. We didn’t wait, and I think that’s why we’ve been successful. We didn’t wait a month after the Project DAWN sites were closed. We pivoted and acted and were aggressive about getting restarted.”
Photo provided by MetroHealth