Jordana Latozas, RN, MSN, ACNP, went to nursing school intending to stay in the ICU forever, but her career trajectory took on a life of its own, and in February 2020, she founded the Recovery Mobile Clinic, Michigan’s first mobile addiction clinic.
The Clarkston, Michigan-based mobile clinic provides care and treatment to patients across seven Michigan counties who are recovering from substance use disorder and do not have access to the reliable transportation needed for regular care.
As National Recovery Month draws to a close, Daily Nurse spoke with Latozas about how she is changing lives as she helps patients battle substance use disorder. What follows is our interview, edited for length and clarity.
-Tell us about yourself and your role in nursing.
I’m an acute care nurse practitioner. My first nurse practitioner job was 2010 at an interventional pain management clinic. Much of the education at that time was different than now. Oxycontin and those kinds of medications were still being provided for you. At the beginning of my career, we started seeing the uptick in the opiate crisis, and we started identifying the addiction. Then, I left the pain clinic and started doing hospice and palliative care. I began because with my pain management background, even in the hospice and palliative side, where there’s pain management, there’s always the conversation of the addiction and the other side of the opiate. I come from a family who struggles with alcoholism. So, I’ve always been interested in that mindset of why I was different and could always put alcohol down and walk away. So that was always interesting to me.
But then, in the suboxone clinic, we started seeing the barriers that healthcare has. Not intentionally, but it’s just there. Even in a county like Oakland County, Michigan, which is relatively affluent, transportation was a huge barrier. We would lose around 30% of our patients to follow-ups due to transportation barriers. So, that would mean a relapse. It would mean running out of their medications and, worst case scenarios, death because they overdose. So I put my head together with my husband, who sells RV’s for a living. And it’s funny how these conversations come about sitting around the kitchen table playing a card game. And jokingly, he said, “Why don’t we just put a clinic in an RV ?” I was like, “Why don’t we put a clinic in an RV!” I started researching the medical models. In 2020, we got the unit and rolled it out with the focus of bringing Vivitrol, namely, the non-addictive naltrexone, into the community places where we’re now at SHAR House in Detroit, and other transitional houses, homeless shelters, trying to ease that transitional burden and inspire nurses like me to do exactly what we’re doing. I’m trying to teach other providers not only about ending the stigma and about Vivitrol and increasing access but also about taking community health into a different area and trying to train other providers about what the mobile model looks like and how they can improve themselves.
-Did you become a nurse to serve your community? Or did your role happen when you fulfilled a need you saw out there?
When I entered nursing school, I intended to stay in the ICU forever. It’s funny how the universe puts things in your path, and your career trajectory takes its own life. It may be different from what you expected it to be initially. Looking back and seeing where the right people came into your path at the right time and the right interactions, a clinic like the Recovery Mobile Clinic can blossom. It’s very empowering. And it’s empowering for other nurses looking at this, saying that they don’t have to do the cookie-cutter jobs of being in the nursing home, the hospital, or the bedside. Nurses do their best in a community setting or when we’re engaging with patients directly, educating, treating, preventing, and helping patients. In our case, we’re trying to transition patients back into a higher level, more traditional level of care and treating them as we’re bridging them over.
-You founded the Recovery Mobile Clinic, Michigan’s first mobile addiction clinic, in 2020. Talk about its impact on Michigan and how you’re helping patients battle substance abuse disorder.
When we started going into cities and municipalities and telling them we would be doing a mobile addiction clinic, the universal response was, oh, my gosh, that’s amazing. You’re so cool. Do it somewhere else. And that’s the stigma talking. I joke that they saw us like the pied piper like I was going to bring a problem with me, and they didn’t recognize the issue they already had. Then we entered COVID. So when we started doing COVID screens, it was to keep people in the shelters. We had to get people into the treatment centers and keep them in a shelter. So we started doing COVID tests to keep people in housing, but then it branched into the vaccines. The municipalities are seeing us as a solution now because the mobile clinic could bring those vaccinations into most areas that nobody wanted to go into. Nobody wanted to go into the homeless shelters and test everybody. So now we are a solution to their problem. They realized I wasn’t the pied piper. Then the barriers came down, and we went into seven counties within the first year and a half. It went fast. Since COVID has come down, we’re seeing more of this transition back to what we intended to do. The numbers of patients being seen are skewed slightly because of the COVID overlap, but for the first time, 95% of our cases are not COVID-related. I’ve tried to treat over 5,000 patients this year, so we’re growing quickly because we now have three full-time units. So we’ve got a full load of nurse practitioners and paramedics. A whole team of staff that are out there helping patients.
-What services, besides COVID screenings and vaccination, does the Recovery Mobile Clinic provide Michigan residents?
We offer a lot of primary care services and medication refills. You’d be surprised how many people come out of jail or an inpatient facility and can’t get into their primary care doctor or see a psychiatrist for a month, and they will only fill their meds. What are they supposed to do? They need meds for psych, diabetes, or hypertension, and nobody will fill them until they have an appointment in a month. There are other services we offer, but when we drive around, and it says Recovery Mobile Clinic in giant letters, sometimes it gives people a little bit of extra dignity or a little excuse that I’m just going in there for my COVID tests. I’m just going in there for my flu shot. There are so many other things that we’re doing. So it’s easy for people to save face. I hate to say the stigma is alive and well, but we must know that that is there.
Recovery Mobile Clinic
-How can we help end the stigma associated with substance abuse?
I keep bringing up ending the stigma all the time. And it’s super important. And there are a lot of ways to end the stigma. One of the best ways to stop the stigma is to tell their story. Tell your story about your addiction, family experience, or someone you’ve worked with. People have to understand that an addiction isn’t rare. It’s not unique. It’s very common. And the more that we can bring it out of the closet and start talking about the realities of addiction in our community, families, and personal lives. The more people willing to talk about it, the more we will get help. Right now, there is a fear of asking for help. It’s mostly mental illness, where people are more scared of admitting the problem than actually the results of the illness, which could be death. We have to turn that around. And the best way to do that is to get people talking about it and opening up so those communications can happen. So, I would like everybody to focus on telling your story, especially in recovery. Be okay with talking about it with others because your story can and will save somebody else’s life, even if you don’t feel like it.
-September is National Recovery Month. Talk about how recovery is possible for everyone.
Recovery is possible for everyone who wants it. And that’s important to understand. You can’t force a behavioral change on somebody until they’re ready. We can educate and teach, we can provide tools, we can give them support, we can give them the ammunition so they’re prepared to make that real serious commitment. We can’t force someone to stay sober as much as we know that their life would improve if they could, but they have to recognize that it can be done and that they’re worth it. Then, acknowledging that the struggle will be worth the long-term goals. We see that a lot with our patients, unfortunately. Addiction is a symptom of the main problem, whether mental illness, depression, anxiety, abuse cases, or PTS. We’re always going to see that overlap. But we’re treating people who are lost, hopeless, lost sense of purpose that you’ve given up on. They’re searching for anything meaningful outside of the addiction. And when you bring them in, and they’ve been told they’re not worth it, shunted aside, or not taken seriously, you know their concerns aren’t recognized, so they don’t think anybody else cares. So why should they? I have one good example of this, and he’s essentially doing well and has been sober for over six months. So, we asked a patient to do a testimonial. Would you write something for us to put on our website? So this is a public website; he knows the world will see this and described himself as a throwaway person. That was his description of himself. We would never describe ourselves as a throwaway person. But that’s how he saw himself even six years sober. And he was having a hard time seeing value in the mirror. And that’s what we’re fighting. That’s the battle that we’re having.
-The use of fentanyl is a growing crisis. Can you talk about how NARCAN approval is a game-changer?
NARCAN saves lives. So anytime we have a medication that’s available that you can save a life, whether that’s your own, or your child’s, your husband, your wife, your parents, your grandma, your cousin, your best friend, anytime we have a way for people to prevent death for someone they love, that’s always a good thing. We think that with aspirin for heart attacks or EpiPens. Being able to have that awareness and that implementation is huge. So the other part of it, too, though, is it’s encouraging people to get educated. If it’s over the counter and I can get it, I need to know how and where to use it. And that’s a critical part of NARCAN’s stigma. So, getting people to be comfortable with having that medication around and utilizing it is an important step towards ending the stigma and getting people who need help willing to go and get the help. Having NARCAN over the counter, from the stigma standpoint, is a good thing. You don’t have to ask the provider for NARCAN or get a prescription. Then, you don’t have an uncomfortable conversation with the pharmacist behind the counter. So again, it’s just decreasing those barriers and increasing that accessibility that is extremely important because it will save lives. And we’re not just talking about fentanyl. We have to remember that children will get into pill bottles. Elderly parents or grandparents may forget how many pills they took that day, or they all look like little white pills, and you mix up the bottles. So, accidental overdoses happen not because of intention but can still be reversed in the same way.
The other thing that we have to offer, and I know this is a little bit more controversial, but with the legalization of marijuana, we have started seeing an uptick in contaminated marijuana products. Fentanyl is finding its way into marijuana products. So, the young population may not intentionally try to take fentanyl or another type of opiate. They don’t know what’s in it. They don’t know what the potential for having an inadvertent opiate substance inside a marijuana product is, and it can still kill you whether you intend to take it or not. And so you have to have that population aware of how to use it, how to save their friend’s lives, you know, if that were to occur. The part that is super important that people need to know is that if you use NARCAN, you have to get that person into a higher level of care. NARCAN is designed to work extremely fast. We want it to absorb into that mucous membrane, which will be the effect so that person can start breathing, but it also wears off quickly. It doesn’t hang around for an extended period, but the medication they took will hang around for a while. We must get them into a hospital because a patient will return to the overdose. So if you leave them, they’ll overdose again. A lot of people don’t want to call 911. They’re scared that they’re going to get arrested or they’re going to get in trouble. They’re not going to arrest you for saving someone’s life. They may give you a pamphlet, lecture you, or ask if you want to talk to somebody. They’re just going to take the person that needs the attention and save their life. That’s it. That’s all they’re going to do.
-How can schools keep students safe, and what do parents need to know about fentanyl?
If your child is unresponsive or not breathing, you always want to use NARCAN first. Keeping it in your medicine cabinet, car, or purse is easy without going over the counter. Just keep it around everywhere you are because this can happen very fast. If we have an unresponsive person, even if we don’t know what it is. It could be a heart attack, someone choking, or anything else. It’s not going to hurt them. With opiates, they’ll get drowsy and stumble. They may not be breathing; if they’re breathing, it might be agonal breathing. It sounds like strong snoring, which means they’re not getting oxygen. So you want to ensure you’re giving the NARCAN, initiating CPR, and calling 911.
Education with kids is super important. Teenagers and kids want to talk to their moms and dads about drugs. But you have to have difficult conversations about the fact that marijuana is legal, but people make stuff, and it’s not always what you think it might be, so we have to pay attention. Kids don’t want to hear that their friends will give them something bad or that their friends don’t have the best interest in heart for them. Sometimes, you have to have those kinds of conversations in schools. I firmly believe schools should have NARCAN available. And again, not in a way where kids must go into the office and talk with a teacher or somebody about what’s happening. Because you have to remember it might not be the kid having the problem. They’re living with parents or with older brothers and sisters or grandparents or aunts or uncles. If you have NARCAN available, it should be where the fire extinguisher and the first aid kit are so they see where those rescue things are. And if a NARCAN walks off, then replace it. It’s good to have around if they need that. I always say increase the accessibility; hopefully, it’ll save somebody’s life.
-Talk about other healthcare challenges and the growing role of nurse practitioners in delivering care to patients in underserved communities, which you’re doing with your mobile clinic.
There are always challenges in healthcare, and the unfortunate reality is that we need more primary care doctors. Medical schools are turning out different numbers than they used to, and nurse practitioners and PAs are one of the top-growing jobs out there right now. And we’re different. We’re not the same as doctors. And that’s good, especially in nursing, where nurses are more geared towards getting out into the community and engaging with patients. Starting with education, doing exactly what we’re doing, and pulling them back in so they interact. What we’re trying to do with The Recovery Mobile Clinic is reinvent the community care way of expecting people to come into a brick-and-mortar rather than taking the services out to the patient and meeting them where they’re at. Because when you have somebody who may be struggling with homelessness or mental illness, going into a big, sterile facility can be intimidating. Sometimes, when we’re in the facilities or out of the shelters, it takes some patients two or three times to start trusting us, building rapport, and understanding what we’re there for. And so they’re ready to open up. You have to have that accessibility for them and the right culture and communication to start breaking down those barriers. So, the Recovery Mobile Clinic focuses on education with therapeutic teaching, making people comfortable talking to others about their addiction problems and realizing that these people are no different from any other patient you’ve treated. It’s a disease stage, just like anything else is. And we must start teaching everybody the right questions to ask and how to engage. And it’s a very learnable skill and very rewarding because when it does work, it’s amazing.
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