A Van That Parks Where People Use Kept More of Them Alive. Build More Vans.

Picture the second option. You’ve been told about a clinic across town that can start you on buprenorphine and get you on HIV prevention pills. A peer worker gives you the address and a bus schedule. Now picture the first option: the clinic is a van, parked on the block where you already are, and the peer worker walks you up the steps.

The second option is how American addiction care mostly works. A new trial says the first one keeps more people alive.

HPTN 094, published in JAMA Psychiatry by co-chairs Steven Shoptaw of UCLA and Nabila El-Bassel of Columbia, enrolled 409 adults who inject drugs in Houston, Los Angeles, New York, Philadelphia, and Washington, D.C. None were on medication for opioid use disorder when they started. Everyone got 26 weeks of peer navigation. Half got it alongside a mobile unit offering buprenorphine or other medications, PrEP, and basic medical care; the other half were navigated to regular brick-and-mortar services. Deaths from any cause were 71% lower in the mobile-unit group. “These findings suggest that delivering low threshold services through mobile units could save lives,” said NIDA director Nora Volkow.

Now the calibration, because it matters. Mortality was a secondary outcome, not what the trial was designed to measure, and the number of deaths was small. Coverage has disagreed about how statistically solid it is, and the NIH’s own release joins the investigators in calling for replication. The primary goals, more people on daily PrEP and on addiction medication, showed no difference between arms: about 14% of all participants were on medication at both 26 and 52 weeks. That’s a real gain from zero, but it’s the same in both groups. So the honest read is: the van didn’t obviously get more people onto pills, and yet fewer people in its orbit died. The plausible reason is the thing that’s hard to put in a table: regular, low-threshold contact with people who know your name.

If you’re in active use: that contact is worth more than it feels like. Go to the van. Take the naloxone. You don’t have to commit to anything to stand in line.

If you run a program, the question for your next team meeting is simple: what would it take to deliver one service, even just buprenorphine starts and naloxone, from where people already are instead of where your lease is? Philadelphia put a methadone van in Kensington last year. More on outreach models in our harm reduction coverage.

Treatment that waits for people to arrive is treatment for the people who were already going to make it.