"I literally probably have the best job you could ever have," Masula says, grinning. "I get to go to work and see people who are trying to change their lives every single day for the better."
Masula is the logistics coordinator for Positive Recovery Solutions, an addiction recovery clinic that combines behavioral counseling with monthly shots of Vivitrol, a form of extended-release naltrexone, which blocks cravings for opiates and alcohol.
The travel trailer Masula sets up on this dreary January morning is unassuming, but in the fight against the opioid epidemic, it's saving lives and bringing resources to areas and people who need it the most.
According to the US Drug Enforcement Administration, between 2015 and 2017, drug-related overdose deaths in Pennsylvania increased 65%. In 2017, the Keystone State experienced 5,456 drug-related overdose deaths, a rate of 43 per 100,000 people, nearly twice the national average.
The mobile clinic is the brainchild of Positive Recovery Solutions Chief Operating Officer Amanda Cope, who is no stranger to addiction.
Her mother died of cancer when Cope was 6, and her father was left to raise their four children. "We had very little parental supervision. I took my first drink at age 9; I stole my daddy's vodka. I became a daily drinker by the time I was 16," Cope explained with the ease of someone telling a familiar story. "I ended up being 27 years old, drinking two fifths of vodka a day to not be sick."
It was around that time, Cope says, she hit rock bottom. After blacking out in a bar bathroom, she had a seizure, fell and shattered a porcelain toilet tank. When a friend came to find her, Cope, still twitching, ended up hitting and cutting the friend.
"My entry into rehab was a 'I've gotta do something, because I've really messed up here.' "
Cope entered treatment at 28 years old. "Once I got there, I realized how sick I was; my denial was thick."
While she was detoxing in the emergency room, the kindness of a nurse changed her life.
"I absolutely hated who I had become. This nurse ... she dimmed the lights and cracked the door. I heard her tell the nurses, 'guys, be quiet; that girl's really sick in there.' That was the first time that somebody saw me for what I was and showed me compassion and empathy. It was, to this day, the most profound moment of my life. In that moment, I said, 'I'm going to be that for someone one day.' "
And she is. Now sober for nearly 13 years, Cope is a registered nurse. After working with patients for several years, she teamed up with her cousins, who were in recovery for opioid dependency, to form Positive Recovery Solutions to help those battling addiction.
When she learned that some of her patients were driving hours just to get treatment, Cope decided to hit the road to help close the distance.
A medication safety net
According to Cope, Positive Recovery Solutions' role is to medically manage patients on Vivitrol. The clinic works on a referral basis and receives between 200 and 400 referrals a week. However, many of those patients do not show up for treatment.
In the parking lot, a steady stream of patients is in and out of the trailer. Whether they're regulars or hoping to try the injection for the first time, the process is the same, starting with a drug screening.
The trailer has been set up as a doctor's waiting area, with Masula as receptionist. Some documents are kept in an oven-turned-filing cabinet. Patients sit on couches, waiting for Masula to give them the results of their screenings. Once cleared, they head into a small private room that's been converted into Cope's office.
"How's everything going since we last saw you?" Cope asks her first patient of the day warmly. The two discuss how the drug is working and how counseling is going. "No new social stressors for you?"
Before delivering the injection, Cope reiterates the risk of overdose and death if the patient tries to challenge the medication and use opioids or alcohol while on it. She gives the shot, sending the patient on the way and congratulating them on almost one year clean.
Cope stresses that the treatment is not for everyone.
"We firmly believe that the work of recovery comes from the behavioral health piece; the medication is meant, by our philosophy, to be a safety net," she explained. "It's going to remove your cravings, and it's also going to put a block in place that prevents you from successfully being able to use an opiate or alcohol. This safety net will keep this patient craving-free and blocked while they do the work of recovery, which is developing healthy coping mechanisms, changing behavior patterns and changing people, places and things."
Cope herself never used Vivitrol; the drug wasn't on the market when she stopped drinking. Instead, she remained sober with the help of a 12-step program.
Addiction 'was my entire being'
Dr. Joseph Lee, medical director of youth services at the renowned Hazelden Betty Ford Foundation treatment centers, believes that in the fight against the opioid epidemic, the use of some form of medication is crucial.
"People talk about research and best treatments, but that doesn't mean that any treatment is going to be 100% effective," said Lee, who has no involvement with Positive Recovery Solutions or the clinic. "That said, the research is clear in saying that the use of medications to prevent overdose and to fight cravings are critical."
A study published last year found that despite the availability of life-saving medication-assisted treatments, referred to as MAT, only 30% of those treated in the emergency room for an overdose received a medication for their addiction.
According to Lee, the patients who thrive on Vivitrol are those who choose it, not those who are coerced into taking the drug.
"I see young people, young adults and teenagers, that chose Vivitrol and take the injection every month do very well. But the people who are on the fence about it, they might do one or two injections and not follow up thereafter," he said. "We have to encourage dignity and autonomy in the use of these medications, meaning that people self-select for the kinds of medication that they might want to take."
There are other medications approved by the US Food and Drug Administration for the treatment of opioid addiction, including methadone and buprenorphine. All three medications are considered the gold standard for treatment. When they are combined with behavioral therapy, those who are treated reduce their risk of death.
But Masula says Vivitrol worked for him. Before the 27-year-old was an employee, he was a patient.
After being prescribed pain pills for a foot surgery at 15 years old, Masula says, he began abusing them and then turned to heroin, which was cheaper and easier to get. He was in and out of treatment at least four times.
"I got to the point where it was either get clean or die. And dying was a really viable option at the moment," he said. "I can remember sitting at home. ... I knew where there was a firearm, and I was contemplating whether to go get it and take my life. And, I don't know, something in me said, 'see if you can get help.' "
Masula describes his experience with Vivitrol and counseling as life-changing.
"For me, it was like night and day difference. It's like when people are on their phones all the time and they are like 'OK, I got to check my phone. OK, I got to check my phone. OK, I got to check my phone' -- getting high was 10 times more than that," the father of two says, adding that he quit jobs because they took time away from getting drugs. "It was more important than eating. It was more important than breathing. It was my entire being.
"From the point of me getting the Vivitrol shot, I thought about using twice in 13 months. For me, it was literally like a gift from God."
Now sober, Masula helps others, driving the mobile clinic to rural areas hit hard by the epidemic.
"I'm in recovery not to only better my life but to better others' lives," he said. "That's what I'm supposed to do is help make the world a better place."
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