WOONSOCKET, R.I. — The sun barely rises when John Hayes gets behind the wheel of a 27-foot-long RV and starts to rev up the engine.

Hayes sits on the edge of a mostly empty parking lot in Providence, Rhode Island, right outside of a methadone treatment clinic where, even at 5 a.m., patients start lining up.

But Hayes is not there to help people inside the brick-and-mortar clinic. Instead, he's taking the converted RV about 30 minutes north— to Woonsocket, Rhode Island. It's a community with some of the highest opioid use rates in the state.

"They’re just nice people that hit a bump," Hayes said.

It does not take long for patients to arrive.

One of the first people to arrive is Raul Rodriquez. Addicted to drugs for more than 20 years, Rodriquez use to have to travel 30 minutes to Providence to receive the methadone treatment he needs to get better.

But now, this first-in-the-nation mobile methadone clinic is bringing the medicine to him.

"It's wonderful. I live around the corner, you don't have to drive. It's right here," he said.

Methadone is a medication used to help people reduce or quit their use of heroin or other drugs. By increasing ease and access, the mobile medical unit hopes to keep patients on the right path.

"Substance use disorder is just a disease of the brain," said Linda Hurley, president of CODAC Behavioral Health, which owns and operates the mobile unit.

Last month, CODAC received approval from the Drug Enforcement Administration (DEA) to dispense methadone at mobile treatment sites. Aside from the convenience, it's a more cost-effective way for treatment centers to operate. Instead of $4 million for a new building, CODAC can spend closer to $400,000 to renovate an RV.

"This is a highly effective, efficient and kind way to provide care to individuals that are dying," Hurley said.

This type of innovative methadone treatment couldn't come at a more critical American juncture. According to the Centers for Disease Control and Prevention, an estimated 107,000 people died of drug overdoses in the U.S. in 2021. An estimated 75 percent of those deaths involved an opioid but only 18 percent of people with an opioid use disorder received medication as treatment.

"With a mobile unit, we go to individuals and see them when they can be seen, and that’s really important," Hurley noted.

There's another layer to all of this. It's keeping patients from having to go to a traditional doctor's office setting, which comes with its own set of stigmas.

As a physician specializing in addiction medicine, the mobile medical unit is a new frontier for Dr. Cara Zimmerman.

"This is definitely meeting someone where they're at," Dr. Zimmerman said.

Not only can she offer patients methadone treatment, but she can also help with wound care or write a prescription.

"This is more we're here; we're coming to you on your schedule and whatever, as much or as little as you need," she added.

Communities across the country are visiting the mobile clinic to see what's working as more treatment centers apply for DEA approval to get other mobile methadone clinics rolling nationwide.

"Most of them are just regular people who are coming in early to go to work. They're coming in before their day starts, so they can get their methadone and live a life," Hayes said.

JOHNSON, Vt. — It's hard for me to express the amount of admiration I have for Dawn and Greg Tatro.

After losing their daughter to an overdose, Dawn and Greg Tatro set out to not only help people in recovery but also change how it's done.

The organization, Jenna's Promise, is named in honor of their daughter.

"One just said to me again tonight, he goes, 'I used to come to Johnson (Vermont) for drugs.' Now, he goes, 'I come to Johnson for recovery.' He goes, 'It's pretty awesome," Dawn said.

The Tatros' dreams of expanding how they help people have expanded over the course of a year. They now have a café that employs their residents and a health center.

"Once you get that veil of addiction off their, off their, face and you see the real person come out, it's incredible," said Greg.

The best part they say is how the town has embraced its residents. By going to the cafe, the people are actively participating in their recovery. It's a true, "It takes a village" mentality, playing out in real-time.

"It's cleaning the town up," said Dawn. "It's helping people and, uh, and it's creating this community."

Will Eberle is the executive director of the Vermont Association of Mental Health and Recovery.

"Unfortunately, we're still tracking at a very high rate of overdose deaths in Vermont. Currently, we have, according to our latest statistics, 151 overdose fatalities in Vermont through August of this year, and around 80% of those have included fentanyl," Eberle said.

There's no national data out yet for 2022, but with the prevalence of fentanyl across the nation, experts like Eberle are expecting it to be another year of tragically high numbers nationwide.

However, just like Dawn and Greg have seen, Will says the good news is that he's seeing less stigma as communities step up.

"Over time, it's starting to become sort of the community's business to work on these things more than the recovery sectors business, which is very heartening to see," he said.

The Tatros and Eberle believe the only way to completely flip the script on addiction and overdose deaths is for everyone to realize they have a role and to invest in the people and the places impacted.

They're hoping next year, even more communities see the value in the people working to make their lives better.

"It seems so simple, but to believe in someone, it's sometimes really what they need," said Dawn.

URBANDALE, Iowa — Dr. Alan Bollinger has dedicated his career to helping people overcome addiction.

"When you look at a lot of these people, they've been horribly abused," he said.

Bollinger is a medication-assisted treatment provider at a primary health care clinic in Urbandale, Iowa. Bollinger uses a combination of counseling and buprenorphine to treat people living with addiction.

"If you look at the way people are treated, in general, for their addictions, a lot of times it's stigmatized and the focus is on the behavior rather than on the person, and that makes it difficult to get well," he said.

"Like the rest of the country, we have seen more opioid use and more overdose related to opioids over the last 20 years, and we're also like the rest of the country seeing fentanyl in more than just the opioid drug supply," said Dr. Alison Lynch, a psychiatrist, family physician and addiction medicine specialist at the University of Iowa.

The university has played an essential role in training providers on prescribing buprenorphine, using nearly $4 million from the state’s share of the opioid settlement money.

Lynch said they’ve trained 250 prescribers in the eastern part of the state and more than 100 medical students.

However, one of the biggest hurdles is helping rural health care providers overcome the stigma of using the medication, which is an opioid. Lynch said buprenorphine attaches to opioid receptors in the brain but does not give the effect of being high.

"They don't have to worry about finding another opioid. They don't have to worry about cravings. They don't have to worry about going into withdrawal," she said.

The progress being made is measurable. According to a study from the University of Washington, 40% of rural counties in 2016 had at least one prescriber of buprenorphine. In 2020, the number increased to 63%.

The federal government is putting in money too. In September, the Health Resources and Services Administration announced $104 million would go to rural communities to combat the opioid epidemic, including $10 million for MAT programs.

"The mental health crisis, the substance abuse crisis, they're the same thing and the truth is there's one crisis, and those two things are symptoms. The real crisis is relationship crisis," said Bollinger.

He hopes that, along with the dollars coming in, people's minds will change when it comes to addiction. He believes a changing mindset, along with treatment, is how the crisis can come to an end.

Babies born to opioid users had shorter hospital stays and needed less medication when their care emphasized parent involvement, skin-to-skin contact and a quiet environment, researchers reported Sunday.

Newborns were ready to go home about a week earlier compared to those getting standard care. Fewer received opioid medications to reduce withdrawal symptoms such as tremors and hard-to-soothe crying, about 20% compared to 52% of the standard-care babies.

Babies born to opioid users, including mothers in treatment with medications such as methadone, can develop withdrawal symptoms after exposure in the womb.

Typically, hospitals use a scoring system to decide which babies need medicine to ease withdrawal, which means treatment in newborn intensive care units.

"The mom is sitting there anxiously waiting for the score," said the study's lead author Dr. Leslie Young of the University of Vermont's Children's Hospital. "This would be really stressful for families."

In the new approach — called Eat, Sleep, Console — nurses involve mothers as they evaluate together whether rocking, breastfeeding or swaddling can calm the baby, Young said. Medicine is an option, but the environment is considered too.

"Is the TV on in the room? Do we need to turn that off? Are the lights on? Do we need to turn those down?" Young said.

About 5,000 nurses were trained during the study, published Sunday by the New England Journal of Medicine.

Researchers studied the care of 1,300 newborns at 26 U.S. hospitals. Babies born before training were compared to babies born after.

The National Institutes of Health funded the work as part of an initiative to address the U.S. opioid addiction crisis.

"One of the great strengths of the study is its geographic diversity," said Dr. Diana Bianchi, director of the branch that researches child health and human development. "We've had newborns enrolled from sites as varied as Sioux Falls, South Dakota; Kansas City, Missouri; and Spartanburg, South Carolina."

Many U.S. hospitals have adopted the new approach, Bianchi said, adding she hopes the research will lead to recommendations from pediatrics groups.

Researchers followed the babies for three months and found no difference in urgent care or emergency room visits or hospitalizations — reassuring evidence about the safety of shorter hospital stays.

The new approach could yield "tremendous savings" in hospital resources, Young said, although the study didn't estimate cost.

Researchers will follow the babies until age 2 to monitor their health.

Mothers want to be involved, Young said.

"For the first time, they feel like their role as a mom is valued and like they're important," she said. "We know that those first moments of a mom and a baby being together are really critical to bonding."

The opioid epidemic claims the lives of thousands of Ohioans every year, with many leaving families and children behind.

A local nonprofit is stepping in to help bring joy to those children during the holiday season.

Project Noelle’s Cuyahoga County chapter held its annual Christmas gift distribution at the United Methodist Church of Brook Park Saturday.

The organization was founded four years ago by Keli Clark, a mom in the Sandusky area who lost her daughter, Noelle, to the opioid epidemic.

Since then, chapters of the organization across the state and in Florida have helped children touched by the epidemic with their annual Christmas gift distribution and other events held throughout the year.

Robbie Slapnick of Cleveland is one of the people being helped by the organization.

"I have four grandkids that are my life. So I do everything I can resource-wise to provide Christmas besides what their beautiful mom does,” said Slapnick.

She said it’s hard to make ends meet and make sure there are gifts under the tree.

“It's Christmas. People don't have the money. And the kids expect so much now,” said Slapnick.

Fortunately, she has a couple of angels on her side from Project Noelle.

“For me as a grandma, especially with grandkids, it is so easing on the soul to know someone is helping you,” said Slapnick.

Project Noelle’s Cuyahoga County chapter partnered with several groups for its distribution this year, including the Blockbuster Society, Cuyahoga County Board of Health, Matt Talbot for Men, The Woodrow Project, and the area National Guard.

It's great. It's great. The outpouring from the community is just overwhelming,” said Sue Derov, co-director of Project Noelle’s Cuyahoga County chapter.

Derov says the need is growing. They helped 350 kids last year and are helping 475 this year, and the gifts donated by good Samaritans keep getting better.

“Bikes, TVs, iPads, you know, so it's a great, great thing,” said Derov.

But still, Derov wants their reach to grow even wider and is hoping more people continue to learn about their organization.

“I feel as though we're really only touching on Cuyahoga County. We’re basically, you know, reaching the people on the west side and it could be so much more real,” said Derov.

Those who do know about the organization, like Slapnick, can testify to the impact Project Noelle has had on their lives.

"Last year, when I came home, I felt like I was driving a sleigh home. I felt like Santa Claus. And to me, that moves me. This moves me,” said Slapnick.

More information about Project Noelle can be found here.

Jade Jarvis at Newsy first reported this.

A federal judge overseeing litigation related to the nation's opioid epidemic ruled Tuesday that lawsuits targeting Purdue Pharma and other drug companies can move to trial even as the OxyContin maker tries to reach a settlement.

The ruling was one of several issued by U.S. District Court Judge Dan Polster, who is preparing for a trial scheduled for Oct. 21 over claims from the Ohio counties of Cuyahoga and Summit.

It would be the first federal trial seeking to hold drug companies, distributors and pharmacies accountable for an overdose and addiction crisis that has killed more than 400,000 Americans since 2000. More than 2,000 local governments have sued the industry, with most of the cases gathered in multidistrict litigation under Polster. The first trial is partly intended to answer legal questions that could arise in others that would follow if a settlement can't be reached.

Polster issued six rulings Tuesday denying motions for summary judgment from various groups of defendants, who had hoped to have at least some claims against them tossed out. While it's not a surprise that Polster denied the requests, the decisions strengthen the plaintiffs' positions with the initial trial less than two months away.

He ruled that civil conspiracy claims against the companies that make, distribute and sell opioids can remain in the case. In his opinion, Polster wrote that it's for a jury to decide whether there is enough evidence to show the companies' actions meet the criteria of a conspiracy claim.

Some of the defendants also sought to have claims tossed out because of conflicts between the underlying state and federal laws; Polster denied those, as well.

Polster also made rulings specific to certain defendants or groups of them. He found that claims should not be dropped against Mallinckrodt, Teva and Actavis, three makers of generic drugs.

They argued that there was no proof they had marketed their generic opioids during certain time periods, but plaintiffs in the case responded that the companies had indeed done marketing. They pointed to their sponsorship of patient advocacy groups that called for more access to pain treatment.

The judge also ruled against a group of smaller drug distributors. They had argued that lawsuits against them should be tossed out because their involvement in the opioids industry was too small to make a difference.

In recent weeks, Polster has ruled against several efforts to keep expert witnesses from testifying on behalf of the local governments.

It's not clear just which defendants might be included when the trial begins. Last month, drugmakers Endo and Allergan settled claims with the two Ohio counties, and more settlements could come in the weeks ahead.

Purdue, a company strongly associated with the opioid epidemic through its OxyContin drug, has proposed settlement terms that would have the Stamford, Connecticut-based company file for a structured bankruptcy and pay $10 billion to $12 billion to settle all claims against it. The Sackler family, which owns Purdue, would pay $3 billion under the proposal and contribute an estimated $1.5 billion more from the sale of another company they own, Mundipharma.

Since details of the deal became public last week, some local officials and state attorneys general have pushed back, saying the amount of money offered is too small. Others have said they want people affected by the opioid epidemic to have a chance to address company executives in court.

Last month, a state judge in Oklahoma ruled that Johnson & Johnson and its subsidiaries must pay $572 million in the first state-court verdict on the opioid crisis. Purdue and Teva Pharmaceutical Industries settled with the state before the trial began.

Meanwhile, Ohio Attorney General Dave Yost has sued to stop the trials involving the Ohio local governments' claims, saying the state's lawsuit should go first.

America has an opioid problem and more mothers are struggling with sobriety.

“At the height of my addiction, I could take anywhere from 20 or 30 Percocets a day if I had them,” said Amanda Martin, who’s opioid addiction started shortly after the death of a child.

“My third born son died shortly after he was born and that just made a huge impact on me,” Martin said.

During her fourth and fifth pregnancies, Martin, a former nurse, started taking pain pills which she says impacted her other children’s health.

“They both had delayed speech patterns,” she said. “My youngest son that I took the most opiates with, he did have some developmental delays.”

Martin’s opioid addiction eventually led to heroin use and ultimately put her in jail.

New research shows during the past two decades, four times as many pregnant women are struggling with opioid use disorder and almost eight times as many infants are diagnosed with opioid withdrawal.

Now, health experts say that many are having a hard time getting proper treatment.

“Hospitals are providing variable care,” said Stephen Patrick, MD, director of the Vanderbilt Center for Child Health Policy. "And we see systems in communities really stretched, everything from local community hospitals to the child welfare system."

He says every 15 minutes in America, an infant is born having an opioid withdrawal, which accounts for half a billion dollars in healthcare expenditures nationwide.

“This year it looks like we’re on record pace once again to have to have a record-number of opioid overdoses,” Patrick said.

While the COVID-19 crisis has made it harder for pregnant women to get into treatment, Patrick says this is a fixable problem, but that America currently lacks to funding and political will to change it.

“As we start to usher in a new administration, I really hope the unique needs of pregnant women and infants affected by the opioid crisis are front and center,” he said.

More help is something Martin agrees with, especially during the COVID crisis.

“We see a lot of people coming in that are relapsing just simply because of the pandemic,” said Martin.

Now three-and-a-half years sober, Martin is working as a recovery coach for Vertava Health in Mississippi and encouraging pregnant moms battling opioid addiction to get help, no matter how hard it may be.

“There’s help out there,” she said. “And there’s non-judgmental places that you can come and you can get your whole life together and never have to live that way.”

A new vaccine being tested could offer another solution to help opioid users with an addiction.

“All my life, I've been working on drugs of abuse like substance abuse disorder, etcetera,” Marco Pravetoni, an associate professor of pharmacology and medicine at the University of Minnesota Medical School, said.

Pravetoni has been working on a vaccine for opioid use for more than a decade at the University of Minnesota.

“It’s a synthetic vaccine that is composed of the target opioid link to a carrier immunogenic protein,” he said.

The vaccine tells the body to make antibodies for oxycodone.

“These antibodies will be selective for the target opioids,” he said.

“The antibodies will bind to the oxycodone molecule and prevent it from getting into the brain, so it should blunt the effects of the oxycodone,” Sandra Comer, Director of the Opioid Laboratory at Columbia University, said.

This prevents the drug “high” and rewarding properties, Comer said.

Comer is leading the clinical trials. Right now, the vaccine for oxycodone addiction is in Phase 1 clinical trial, as approved by the FDA.

“The Phase 1 study is typically focused on safety,” she said. “That study is intending to enroll anywhere between 12 and 24 subjects and then we’ll have to see what they’ll allow us to do next.”

This vaccine will work with other treatments that are currently in use.

“What we’re hoping is that if we give a combination of the vaccine and methadone for example, if somebody relapses after a few months, at least the vaccine-generated antibodies would still provide some protection against overdose,” Comer said.

Emergency physician Dr. Donald Stader said he can see this new, novel solution being helpful.

“We do not know if this is going to be significant in our patient population, but I think it’s very promising,” he said. “We know opioid addiction, even in the midst of the COVID pandemic we’re currently facing, is still the number one killer of Americans under the age of 50.”

“We do see the ravishes of the opioid crisis every day in terms of patients who have overdosed, in terms of patients who come to us in withdrawal, or patients coming to us seeking help with an opioid use disorder. And I will tell you it has gotten much, much worse over the past two years,” Dr. Stader said.

While a vaccine for oxycodone is in Phase 1 trials -- and still has Phase 2 and Phase 3 to go -- Pravetoni said they are developing them for heroin and other drugs as well.

“I've been working on it for so long, but it's also true that this is the first clinical trial ever for an opioid vaccine. And if this works it will open up the field for other medications so that other folks working on cocaine and meth or whatever other type of vaccine that could still help people, that will create a precedent for other teams working on this,” Pravetoni said.

Comer said it will be a while before the vaccine is commercially available, but they hope to eventually create a multivariate vaccine.

“Our overall goal is to develop a series of vaccines that can actually prevent the negative effects of multiple opioids,” Pravetoni said.

Amy Daeschel is a woman in long-term recovery.

"What that means to me is I haven’t found it necessary to use a drink or a drug since August 23, 2017,” Daeschel said.

Daeschel had a successful life until she had multiple foot surgeries at the age of 37. She was prescribed oxycontin for pain.

“Five of them, 30 milligrams a day, and this went on for a year and a half," Daeschel said. "And I had built a strong dependency upon this medication. It turned into an addiction when I started treating emotional trauma. My mother had committed suicide, I was going through a divorce, had domestic violence, I mean everything just hit me at once.”

Once the doctor found out about her addiction, she was cut off. So, she turned to the streets.

“That first $10 bag of heroin came and it was over. Within two months, I had lost everything."

She says it wasn’t until she hit rock bottom that she was able to turn her life around. A state-run addiction operation offered her treatment. She’s been sober since. Unfortunately, that hasn't the case for a lot of others across the country.

Julie Burns is the CEO of Rize Massachusetts Foundation – a statewide independent nonprofit focused on ending the opioid overdose crisis.

“In recent months, the opioid crisis has definitely taken a turn for the worse," Burns said. "COVID definitely caused an uptick in fatal overdoses, primarily caused by the isolation with stay-at-home orders and people couldn’t get access to treatment. They found themselves using alone or using in places where somebody wasn’t checking on them.”

Once somebody’s addicted, it is ridiculously challenging to stop.

“Addiction is a disease of the brain," Burns said. "Opioids change the receptor patterns in your brain and it’s a clinical diagnosis. It’s recognized by the DSM so it’s not debatable that it’s a disease, it’s definitely a disease, and it can be treated.”

Researchers are hard at work trying to find new ways to treat people, researchers like Dr. David Fisher at Massachusetts General Hospital in Boston. He's the chair of dermatology and the director of the melanoma program.

Knowing that UV radiation from the sun stimulates the production of both vitamin D and endorphins in our bodies, Dr. Fisher wanted to study if there is a relationship between vitamin D and opioid response. Opioids also trigger the release of endorphins.

“There’s something paradoxical about the idea that we would have evolved a response that leads us to seek the exposure to the most common carcinogen in our environment – which is ultraviolet radiation," Dr. Fisher said. "Why would that exist? And we predicted or we hypothesized that vitamin D could be a perfect explanation for this.”

His team took lab mice and made them vitamin D deficient. Then they measured their response to either UV radiation or opiates. Their hypothesis that a vitamin D deficiency may increase the risk for opiate addiction held true.

“The dependency was exaggerated; the withdrawal symptoms were exaggerated," Dr. Fisher said. "Even pain control – lower doses of morphine were producing fourfold the magnitude of benefits. Very, very large differences if there was vitamin D deficiency present. Whereas if we corrected the vitamin D level or had normal vitamin D levels, then the responses were much weaker to the opiates.”

Dr. Fisher says this research is still new and they need to validate their findings in a human clinical trial. If nothing changes, his research could help doctors be more aware as they’re prescribing opiates.

“Some of those patients have trouble getting off and ultimately become addicted," Dr. Fisher said. "Could it be that if we identify those patients if they’re vitamin D deficient and just correct the vitamin D deficiency, perhaps that would lower the risk of becoming addicted in the first place.”

In the meantime, Daeschel says she plans to continue her advocacy work to end the stigmas surrounding addiction.

"I’ve got massive scars on my arm," Daeschel said. "And people ask me all the time ‘what happened?’ I’ll look them straight in the face and I’ll go ‘heroin’ and their face, they’re just shocked and tell me ‘oh I could never see you doing that.’ And I’m like ‘but that’s the reality of it. Addiction is so close to home. Somebody’s mother, somebody’s brother, father, sister, uncle, whatever.’”

She wants people to know that recovery is possible and there are many different pathways to get there.

“You will find a freedom that you never knew existed,” Daeschel said.