One population that’s especially vulnerable in this COVID-19 pandemic is people who are addicted to opioids. A medication known by the brand name Suboxone can help, but it can be difficult to access, especially for people who are homeless. In 2019, we reported on a dramatic increase in Fentanyl-related deaths in Contra Costa County, and one doctor who decided to bring the medication to the streets.
Click the play button above to listen to this story. Find an update on how the street medicine team is handling the coronavirus crisis here.
Joseph Mega walks along the train tracks in Baypoint by the Delta. He’s a doctor, but this morning, he’s swapped his lab coat for a hoodie, and the streets are his office. The people he’s meeting today are homeless, and he’s checking up on them. He’s cheery and polite, almost like a camp counselor trying not to wake anyone up.
“Hey, it’s Dr. Mega,” he calls out. “Do you guys need anything?”
Mega leads Contra Costa County’s street medicine team. A nurse, health insurance advisor, and others join him to look for patients. People are camped out in tents. It’s remote enough that police usually leave the people living here alone. The area is full of yapping dogs and cats sneaking around.
“It’s kind of hard to find,” says Mega. “In fact, there was a gas leak where this whole area was evacuated except for these folks. No one came to tell them.”
'No Cravings, No Nothing'
One of Mega’s patients, whom I’ll call Ricky Johnson to protect his identity, stumbles out onto the path, looking dazed, and searching for his beloved pitbull, Chevel-Marie.
Johnson is 49 years old. He has a beard, flashing eyes, and a habit of looking out into the distance, like he’s thinking about other things. He lives out here with his wife. Johnson says he’s been addicted to heroin for decades, ever since his dad died, and he went chasing after any high he could get.
“That’s what a lot of us want, that feeling,” Johnson says. “That’s the reason we did it, to push our problems away.”
Mega recently prescribed him Suboxone, a medication that eases the pain of heroin withdrawal and reduces cravings. Johnson says because of the medicine, he hasn’t used heroin for a few days now. It helps him feel like he can actually get up and function, like he’s normal.
“You could take it in the morning, and the whole day is cool, no cravings, no nothing,” Johnson says. “I’m going to give it a shot, see what happens.”
Thanks to the street medicine team, Johnson can get refills without needing to make a medical appointment himself. Doctor Mega promises to get him a refill later today.
The Street Medicine Team
Mega gets back into his van, a medical clinic on wheels. This street medicine team is part of Contra Costa’s Healthcare for the Homeless program. Inside the van, Doctor Mega can offer people things like vaccines, tests for diabetes and STDs, clean needles, tents and sleeping bags. And, more recently, the team can prescribe Suboxone for addiction.
Mega is happy the medication seems to be working for Johnson.
“He looks fantastic,” says Mega. “His mental state is very stable, the last time we saw him, there’s no way he could have sat down and had a conversation with you.”
Mega trained in family medicine, hoping to find a way to reach people who usually fall through the cracks.
Suboxone can be hard to access for people who are homeless. It’s not easy to keep doctor’s appointments when you live on the streets, or don’t have an I.D or health insurance.
“I feel their frustration with a system that’s not made for them in whatever portion of the system they're trying to access,” says Mega. “It’s not flexible for this population.”
A Rare Model Of Care
There is a similar outreach program that provides Suboxone for homeless people in San Francisco. Other than that, this kind of effort is really rare.
Mega says his team offered the medication to 58 people last year. Some of them have continued receiving prescriptions. Others, he’s lost contact with. Sometimes they’ll vanish for a few months, before asking for treatment again. He knows patients will relapse.
“We'll joke and call them our white rabbits,” says Mega. “They show up, all of a sudden they disappear, and we're like, ‘Where did that person go?’ We feel like we're chasing them.”
The Hamster Wheel
Mega continues his search for patients in the outskirts of Antioch, where dozens of people are camped out in a large field. Over on the edge of the field, one of the outreach team’s patients, Michel Rickford, is sitting on a lawn chair, doing a crossword puzzle. Her gray hair is tied in a tight ponytail. She’s 58-years-old, and says she first tried heroin on New Year’s Eve, five years ago, on the anniversary of her son’s suicide.
“I had a fifty dollar bill, back pay from SSI, and I just thought, ‘That’s it, I want to go out and get high,’” Rickford remembers. “That was my goal. And I've just been doing it ever since.”
Mega’s outreach team recently found her out here, alone in her tent, at the brink of a crisis. She says had sores on each of her arms. And she was dealing with this infection while in full blown withdrawal.
“It was the most excruciating pain you’ve ever felt,” Rickford says. “You’re trying to turn yourself inside out.”
So the outreach group took her to the hospital, where doctors drained the abscesses. The team also helped get her started on Suboxone. For a couple of days, she took it. But then she went back to using heroin. She last shot up this morning.
“It’s a vicious damn circle,” says Rickford. “It’s a hamster wheel you’ll never get off, unless you really, really want to. You have to really want to get off of it.”
Recovery And Harm Reduction
Rickford plans to try Suboxone again in a few days, and make yet another attempt at a clean break. Dr. Joseph Mega considers that a victory. For him, it matters that homeless people like Rickford have access to treatment, even if it doesn’t always lead to a lifetime of sobriety. He knows that Suboxone isn’t the perfect solution, that doctors like him can only do so much.
“If I hold myself responsible for the outcome of every patient I've ever met, then I'm really exaggerating what I can do for people,” Mega says.
After seeing a couple more patients, Mega is done for the day. He hops inside the medical-clinic-on-wheels, and drives off. The team recently landed a federal grant to buy a bigger van, and hire a nurse dedicated to following up with patients with Suboxone prescriptions.
California plans spend at least $230 million in federal funds for a program to expand access to medication for addiction by 2020. In the meantime, Doctor Mega and his team will be outside, bringing treatment to people on the streets.
This story originally aired in January 2019.
You can access Contra Costa’s social service and health information 24/7 by calling the three-digit, toll-free number 211 from any phone. You can also contact them at their website, cccc.myresourcedirectory.com
There is also a free, confidential national helpline for individuals and families facing mental and/or substance use disorders. Their number is 1-800-662-HELP (4357).
