This story is part of The Salt Lake Tribune’s ongoing commitment to identify solutions to Utah’s biggest challenges through the work of the Innovation Lab.

Price • Around 6:30 a.m. the streets are mostly empty as the rain turns to sleet and then snow.

It’s late March, and cold and dark and damp outside. But inside the Ford passenger van Bud Truman is driving, the heater is pumping and there’s no need to bundle up.

It’s so warm inside that Truman slips off his rabbit fur ushanka — a type of Russian hat gifted by a nephew living in Moscow.

He’s 61 years old and grew up in Price, a town with a population a little over 8,000. For the past two-and-a-half years he’s been waking up each morning at 4 and driving the van. Unlike a city bus, riders get a text or phone call before Truman pulls up to their door.

“Wakey wakey,” he half sings into his cellphone. “I’m on my way.”

One by one he picks up his passengers — a woman with a small dog, a man with his hoodie up and earbuds in. People chit chat about the snow coming down. One woman asks if anyone can help reset her Hulu passcode.

Once everyone is accounted for, Truman turns back toward Operation Recovery, a nondescript two-story building. His passengers wait in the lobby and step up, two-by-two, to a window where a nurse hands them a cup of methadone. Some choose to mix in Tang or water to mask the medication’s unpleasant taste.

Truman’s bus is one of four that runs around Carbon and Emery counties — providing transportation to people who take methadone (and other similar treatments like Suboxone) daily to avoid relapsing on opioids. In total, Operation Recovery provides medication-assisted treatment to 169 people across the two counties between 6 and 9 a.m. each day.

Without the buses, recovering users in these sparsely populated counties might not get that treatment. A daily bus ride is a gasoline-powered lifeline to those who are working against all kinds of odds to save their own lives.

“It was built out of necessity,” said Melissa Huntington, executive director of Four Corners Community Behavioral Health, which runs the opioid treatment program and other recovery and mental health services in Carbon, Emery and Grand counties.

Leslie Schwab, 58, woke up at 5:15 a.m. and rode with Truman that snowy March day. He started taking methadone about two years ago to help quit heroin. He started using drugs when he was 15 but managed a decades-long career as an electrician and spent 12 years in the army. He never expected to try heroin. “I swore I never would,” Schwab said. “I did.”

But going to Operation Recovery for a 52-milligram dose of methadone and logging in for online therapy has helped. “This has worked for me,” Schwab said. “It really has.” He’s taking audio engineering and production courses, is working to improve his credit score and dreams of building a house soon.

Cobbling together a program

Carbon and Emery counties were hit hard by the opioid crisis. Between 2006 and 2017 Carbon County had the highest opioid prescription rate in the state, the Tribune reported. In 2008 the prescription rate hit 194.2 prescriptions for every 100 people.

“Every week there was a death in the paper,” said Jeanie Willson, chief financial officer for Four Corners. People were dying, and Willson and her colleagues needed to do something.

The need for a solution was so urgent that in 2017, before opening the opioid treatment program in Price, they transported clients to Provo — an hour and a half drive over U.S. Highway 6 — once considered one of the nation’s “deadliest highways.”

The nonprofit started Operation Recovery in partnership with Project Reality in 2018. That same year, with the help of a one-time U.S. Department of Agriculture grant, they purchased a small fleet of vans and buses to ensure clients could make it to the clinic each day — although with nearly 100,000 miles on most of the vans they are trying to figure out where to get funds to purchase at least two new vehicles.

Four Corners relied on a grant from the Substance Abuse and Mental Health Services Administration to get started. They now sustain the program by billing insurance providers like Medicaid or Medicare.

Providing medications for opioid use disorder (MOUD) is considered the gold standard in reducing mortality and morbidity risks compared to just receiving therapy or psychosocial services without medication, explained Jamey Lister, an assistant professor at Rutgers’ School of Social Work and co-director of the Northeast & Caribbean Rural Opioid Technical Assistance Center.

“I think that the biggest issue is just there’s no local providers in rural areas on average,” Lister said. “So the likelihood that you live in a rural-defined county or community that has an opioid treatment program is slim to none.”

There are only three medications approved by the FDA, and methadone and buprenorphine are the most effective at reducing future overdose risks, according to Lister.

Methadone “relieves drug cravings” and “eliminates withdrawal symptoms” according to the National Institute on Drug Abuse. It also helps manage pain, but doesn’t provide a sense of euphoria that opioids like heroin or morphine do.

“The downside of those medications is that they are highly regulated, especially methadone, and so as a result, it creates barriers to accessing care,” Lister said.

How is the Price program unique?

There are many barriers to setting up a medication-assisted treatment program — from complicated certification requirements to dealing with the stigma that methadone is simply “fighting drugs with drugs.” Even getting to a clinic once it is established can be difficult.

Adequate transportation to treatment programs could be one of rural Utah’s biggest challenges in addressing addiction.

Some places in the U.S. provide vouchers for ride sharing or create mobile clinics and equip vans with methadone and other health services.

But the treatment program in Price is unique. The clinic created its own transportation system to ensure that clients could come and take a daily dose of a potentially life saving medicine. On average, clients remain in the program for two to three years.

When Schwab started the program he didn’t have a car or a driver’s license. He and his wife have a car now, but he’s still working on getting a license. The bus has been a great help. “[Truman] doesn’t judge us, he drives the bus and he helps wherever he can,” Schwab said. “And that’s really nice.”

A little snow doesn’t bother driver Truman — even in the dark — as he expertly maneuvers the vehicle around the quiet neighborhoods in Price and nearby Helper.

After living in cities across the Southwest, Truman decided to move back to his hometown with his family. He sold truck and electrical parts and even oxygen before landing a part-time job driving the bus for Operation Recovery.

“It’s a job, but I do enjoy it,” Truman said. “It’s nice to interact with people and hopefully in my small way give them some comfort.”

Scuba Steve, a small plastic scuba diver, hangs mutely from the rear view mirror, and Truman jokes he’s “the patron saint” of the vehicle. A toy soldier aims a teeny rifle, ensuring “the van remains British,” Truman quips. Despite the early hour, he’s jovial. It’s clear he likes his job and the people he drives each day.

“After a while,” Truman reflected as the morning finally grew light, “they’re like a little family.”