--- title: Roads to Recovery date: 2023-09-14T09:48:00-04:00 author: University of Maryland canonical_url: "https://terp.umd.edu/roads-to-recovery" section: Articles --- # Roads to Recovery *September 14, 2023* — by [Sala Levin ’10](/authors/sala-levin-10) - *Photos by John T. Consoli* > In rural Maryland, a new “been-there-done- that” approach to the opioid crisis offers hope on four wheels. *A white truck was driving down a country road* **In the parking lot** outside the First Church of God in Federalsburg, Md., at an intersection sparsely flanked by an auto parts store, a boxy warehouse and a few tired-looking houses, a white van quietly offers what many people in rural parts of Maryland desperately need but often can’t get: treatment—and genuine understanding—for opioid use disorder. The 38-foot Mobile Treatment Unit (MTU) operated by the Caroline County Health Department is part doctor’s office, part counseling center and part support group meeting. Clients board, meet with a registered nurse in the back to check their vitals, enter a booth outfitted for virtual visits to see a doctor at the University of Maryland School of Medicine (UMSOM) in Baltimore, stop at a restroom to give a urine sample, and wrap up by chatting with a substance use counselor in her office in the front of the RV. A patient’s guide through the process, though, is a peer—someone who’s experienced the ravages of addiction and can listen without judgment to the stories people using drugs may be too ashamed to tell a doctor or a nurse: the sex traded for drugs, the possessions stolen from relatives and pawned, the children neglected in the haze of a heroin high. On this mild June Monday, Jessica Anthony is a burst of color in an otherwise drab landscape. Sporting an orange chevron dress and a blond pixie cut, she is as bubbly as you’d expect a woman who never leaves the house with unpainted toes to be. Today, Anthony is observing how the MTU’s staff handles patient visits, but it wasn’t long ago that she was on the other side, climbing the van’s steps to get help for an addiction to methamphetamine and prescription opiates. Now, she’s part of a University of Maryland, College Park study examining how peer treatment can be a bulwark for recovery—a project with sweeping possibilities that stretch from this rural hamlet to struggling neighborhoods in Baltimore to impoverished shantytowns on the other side of the world. The study is led by the director of UMD’s [Center for Substance Use, Addiction and Health Research (CESAR)](https://cesar.umd.edu/), Jessica Magidson Ph.D. ’13, with UMSOM Associate Professor of medicine Dr. Sarah Kattakuzhy and funded by a nearly $4 million grant from the National Institutes of Health. The work builds off of Magidson’s research training lay people in the U.S. and sub-Saharan Africa to become leaders in grassroots health care in areas where hospitals, doctors or other elements of health care infrastructure are hard to come by. “It’s essential to get community buy-in,” says Magidson, who is also an associate professor of psychology. “The peer model of having someone who’s from your community, who’s been a patient of the service—it’s so important to establish that trust and lived expertise.” --- *mobile treatment unit in parking lot* **Without the preppy** panache of St. Michaels or the boisterous energy of Ocean City, Caroline County and its towns are mostly sleepy stretches of farmland punctuated by gas stations, churches and the odd convenience store. “We were tickled pink just a few years ago when we got a Walmart,” says Sarah Lepore, clinical supervisor in the county health department’s behavioral health unit. “That was a huge deal to our community, because we had to drive 40 minutes to get to one.” Maryland is one of just eight states where drug overdose death rates are higher in rural counties than urban ones, according to the Centers for Disease Control and Prevention’s most recent data, from 2020. Across the state, fentanyl caused 2,034 overdose deaths in 2022, a slight decrease from 2,338 the year before. Caroline County, with a population of roughly 33,000, saw 14 fatal overdoses in 2022; by June 2023, there had already been 13. Nationwide, the CDC reported that a record 109,680 Americans died from drug overdoses in 2022, largely from fentanyl, and estimated that only 1 in 10 people who use drugs receive medical treatment. Factors that fuel the market for drugs are numerous in Caroline County, and mirror other drug-plagued communities in the U.S. According to data from 2014–18, nearly 57% of the population lives below the state poverty line. Jobs are scarce, and many people lack reliable access to transportation to get them to work. The generational inheritance of addiction is also potent. “We’ve got grandparents, parents and grandchildren coming to the MTU,” says Carla Penny, an MTU coordinator with the health department. “They thought this was the way of life, and we’re showing them a different way of life.” As the opioid epidemic sank its claws into Maryland and the nation, there was no physician trained in addiction who served the county, and the closest rehab centers were in Cambridge or Chestertown—distances too great, either logistically or psychologically, for many Caroline County residents to travel. > They thought this was the way of life, and we’re showing them a different way of life.” — Carla Penny, MTU coordinator, Caroline County Health Department Seeing the myriad challenges facing the area, Dr. Eric Weintraub ’80, a professor of psychiatry at UMSOM who specializes in addiction, proposed to the local government in 2018 that they work together to pursue a federal grant for a telemedicine vehicle. He and his team had already been providing telemedicine visits and prescribing buprenorphine to wean patients off opioids through the building that housed the health department, but many residents couldn’t get to the office. On the other hand, the van would be able to meet residents where they are. Now operating out of two RVs with a team of five doctors, a registered nurse, a social worker, two coordinators and two peer recovery specialists, the MTU has become an institution of sorts in the county. For Magidson, the innovative model of the MTU—which treats about 120 people per month—provides an opportunity for her to examine the impact of peer counseling in hard-to-reach rural areas. “Not only do we not have enough prescribers, we also don’t have enough psychiatrists or psychologists anywhere, to say nothing of in these rural communities,” says Magidson. “We’re aiming to figure out how we can best train peers, with their own personal experiences of substance use and recovery, in the interventions that will work best and most efficiently to help support people.” --- *Jennifer Magidson headshot* *two women talk at table* *Roger McKnight — Roger McKnight and Jessica Anthony, above in orange, are peer specialists who share their own experiences with addiction to help MTU clients like Rachel, above with back to camera, navigate a path to sobriety. Every weekday, the vehicle parks in a different spot to serve residents throughout Caroline County.* > I kept seeing other people like myself suffer, and everybody wasn’t from Skid Row. There were doctors, lawyers and everybody else in there. This thing can hit anybody, anywhere.” — MTU administrator Roger McKnight **A shortage of** providers trained in mental health and substance use isn’t unique to Caroline County; across the world, especially in impoverished and rural areas, these kinds of professionals are hard to come by. “We need to identify strategies to increase access to care everywhere,” says Magidson. “The peer workforce has proliferated across the U.S. in recent years, and ultimately we hope the model we are evaluating could be incorporated into peer curricula nationwide.” *nurse talks to patient — MTU nurse Linda Tetrick meets with Maureka, who has been an MTU client for five years. Clients give a urine sample and discuss any concerns with Tetrick before meeting virtually with a University of Maryland, Baltimore physician specializing in addiction.* --- Researchers across UMD are tackling the grand challenge of the nation’s opioid epidemic. Projects include: - A team from the departments of Chemistry and Biochemistry, Cell Biology and Molecular Genetics, and Psychology created a chemical compound that could be an [antidote](https://today.umd.edu/new-umd-compound-could-reverse-effects-of-potentially-deadly-drugs) for both fentanyl and methamphetamine overdoses. It’s currently undergoing experimental testing. - A $1 million grant from the National Science Foundation is supporting a [four-year study](https://today.umd.edu/1m-nsf-grant-to-help-researchers-unravel-illegal-opioid-market-operations) to examine the market for synthetic opioids like fentanyl, led by Distinguished University Professor Peter Reuter, of the School of Public Policy and the College of Behavioral and Social Sciences’ Department of Criminology and Criminal Justice. - Funded by a $1 million federal grant, staff and faculty from the University of Maryland Extension, CESAR and the School of Public Health are training rural educators and lay people in [mental health first aid](https://today.umd.edu/university-maryland-extension-takes-rural-opioid-crisis-52ba86c6-90a7-49bd-959e-bb846f5e5567), intended to enhance treatment for drug use. - CESAR’s Emergency Department Drug Surveillance system is [helping Maryland hospitals](https://bsos.umd.edu/featured-content/empowering-emergency) securely analyze urine samples from patients for the presence of fentanyl and other substances. Those insights into their communities’ drug use can guide testing and treatment practices. **Issue:** [Fall 2023](https://terp.umd.edu/editions/fall-2023) **Types:** [Features](https://terp.umd.edu/category/features)