The Van Vs. An Opioid Addiction: Taking Treatment To The Streets


On the streets of Boston, the potholed path to treatment often starts with a sandwich. Egg salad is the favorite. Today it's ham. Phil Ribeiro tucks one into the bag of a man who is breathing, but either so sedated or deeply asleep that he's difficult to rouse.

"Hopefully he doesn't wake up next to a flock of Norway rats," says Ribeiro, a public health advocate with AHOPE, the needle exchange program run by the Boston Public Health Commission.

Ribeiro moves on, looking for more ways to spread "a little bit of love" among the dozen or so sleeping bags under a bridge within sight of Boston's TD Garden.

"Our whole focus is being a bridge to care, a bridge to addiction treatment," says AHOPE director Sarah Mackin.

That bridge includes a physician and an oversized white van that parks daily in one of four overdose hot spots around Boston. The Care Zone van, funded by the Kraft Center for Community Health at Massachusetts General Hospital and the GE Foundation, is one of a half dozen or so projects across the country testing models for this theory: If the U.S. wants to end the opioid epidemic, it must make treatment as available as drugs.

The Care Zone team pairs veteran outreach workers with a doctor and a case manager. Ribeiro and Mackin, veteran street workers, typically make the first contact with an occupied sleeping bag. Dr. Jessie Gaeta, chief medical officer with the Boston Health Care for the Homeless Program, approaches once it’s clear that a new face won’t send the person back into hiding. She knows many of these prospective patients feel shunned by mainstream medicine.

"We’re trying to let people know we’re not there to arrest them. We’re not there to clean up their encampment and kick them out," Gaeta says. "All we want to know is, do we have something you need and want, and if we do, great, here it is. And so we gradually build a relationship that way."

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