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The Guardian
10-05-2025
- Health
- The Guardian
Can a methadone-dispensing robot free up nurses and improve patient care?
Lanea George pulls open a steel security door and enters a windowless room where a video camera stares at what looks like a commercial-grade refrigerator. The machine, dubbed Bodhi, whirrs and spins before spitting out seven small plastic bottles containing precisely 70ml of methadone, a bright pink liquid resembling cherry cough syrup. It is used as a substitute for morphine or heroin in addiction treatment. She scoops the bottles off the tray, bundles them with a rubber band and sets them on a shelf. It's not yet 10am and George, the nurse manager at Man Alive, an opioid treatment program – known colloquially as a methadone clinic – in Baltimore, has already finished prepping the doses for the 100 or so patients who will arrive the next day. 'Bodhi has changed my life and the lives of our patients,' she says. That's because filling the prescriptions requires more than simply pouring medicine into a bottle. It means printing out and attaching the labels one by one, precisely measuring the amounts, sealing the bottles and screwing on the caps. A spill requires the nurse to stop the work, squeegee the lost liquid into a receptacle, measure it, record the incident and destroy the sample. Repeat that process 100 or more times, and it's easy to see why, before Bodhi arrived, the task would have occupied a full day. The pressure to keep up causes many nurses to quit, as does the additional misery of carpal tunnel syndrome, which nurses often suffer from screwing on so many caps day after day, according to George. 'I've seen nurses just leave during a shift and never come back,' she says about previous clinics where she has worked. Now, instead of pouring doses, George spends more time interacting with patients. 'It lets me get more personal, have more in-depth conversations,' she says. 'That's where we get a lot of important information.' More patient interaction was the idea when Amber Norbeck came up with the idea for the machine George now uses daily. A pharmacist in the natal intensive care unit at a Montana hospital, Norbeck said so many pregnant women there struggled with opioid dependencies that as many as 50% of the newborns suffered withdrawal symptoms. Methadone therapy helped the new mothers and moms-to-be, but access undermined their efforts; some clinics she visited had 30- to 60-day waiting lists, while at others patients faced three-hour lines despite a flock of nurses toiling at service windows. Some methadone patients are required to return to clinics daily for their doses. 'It didn't look like healthcare, it looked like tellers in a bank pouring methadone,' Norbeck says. 'For patients with kids and jobs and lives, getting the medication was so time-consuming that they'd just give up.' As US overdose deaths from opioids rose from roughly 8,000 in 2009 to more than 114,000 in 2022, Norbeck saw a country caught between an opioid crisis and a nursing shortage. In 2019, she and Mike Pokorny, an engineer who had developed his own electric motor, began brainstorming ways to automate the assembly of methadone doses. They devised a robotic device that could pour, seal, label and cap the liquid version of the drug – its most popular form – in seconds. A year later, Norbeck quit her job at the hospital and in January of 2021 the duo founded Opio Connect Inc, with Norbeck as CEO and Pokorny as vice-president. They called the device they built Zing, and it came together quickly because it used parts developed for other kinds of machines. 'Existing pharmacy automation solutions weren't built to handle the kind of variability [that dispensing methadone requires],' says Sam Wilson, Opio's COO. 'So while the components of Zing existed, such as robotics, pumps, labeling tech, etc, no one had applied them to this particular challenge.' The creation of Zing coincided with the rise of Covid-19, which provided a boost. Pre-pandemic, patients who were considered 'stable' in their treatment could receive 'take-homes', allowing them to pick up seven or even 14 doses in one visit instead of making a daily trip to the clinic. To reduce in-person contact during the shutdown, federal administrators relaxed the rules on take-homes, making them available to a wider range of patients and in batches for up to 28 days. That policy shift led to more intensive prep and pouring for nurses, but post-Covid research showed that the change caused few problems and provided great benefits to patients, so the new take-home rules became permanent as of January 2024. Sign up to TechScape A weekly dive in to how technology is shaping our lives after newsletter promotion By then, the first Zing had arrived at CompDrug, an opioid treatment program in Columbus, Ohio, complete with its own nickname: Alfie. The seven other Zings that have since come online around the country have likewise received monikers, and the humanizing effect has made them the subjects of naming votes, birthday parties, gender-reveal ceremonies and Halloween dress-up. Together, the fleet has assembled more than 1m doses of methadone. Norbeck expects 30 to 40 more Zings to land by the end of 2025, and the company has its eyes on the 2,100 clinics around the country as well as the prisons, where, she says, 'so many in the population need treatment, but they're notoriously hard places to get nurses to work'. Norbeck knows of no Zing-driven layoffs, but several clinics have been able to leave open positions unfilled and direct the saved money to other treatment programs. 'There were concerns that [Zing] would take nurses' jobs, but the real mission is to free nurses up,' says Pokorny. CompDrug once employed six nurses to pour and distribute methadone all day. Now, three handle the task, aided by a Zing, and the other three take telehealth appointments. All six are still on staff. At Man Alive, Bodhi's arrival gave George enough free time that she also became the clinic's home health nurse, helping patients connect with medical care and following up with them on medications and general healthcare issues. Of course, there's another side to those examples – the nurses who were not hired for open slots, telehealth roles or home health roles. Those jobs may have gone unfilled regardless of robot labor: the Health Resources and Services Administration projects a shortage of 63,720 nurses in 2030, a number that does not capture the attrition accumulated through the pandemic. Norbeck sees her field as one in which robot labor can ease employment shortfalls rather than create them. In Baltimore, George and Man Alive's other nurse, Mandy Scott, have even started holding educational events in the community and attending in-house group therapy sessions to further connect with patients. Put more simply, George says, 'Bodhi lets me be a nurse again.'
BBC News
14-04-2025
- BBC News
'The elite of the criminal world': The men behind the Great Train Robbery
Britain in the 1960s was captivated by the daring of the Great Train Robbery, and the sheer scale of the money stolen. But when the accused men stood trial in April 1964, the judge was determined to send a message that such crimes would not be tolerated. Fourteen years later, several of the convicts talked to the BBC. On 16 April 1964, Robert Welch was one of the 12 men found guilty of a notorious heist in Aylesbury Crown Court. Fourteen years later, in 1978, he was on the BBC's documentary and current affairs programme, Man Alive, and recalled seeing local dignitaries jostle for positions in the courtroom to hear the sentencing. "This was what they had all come to watch. The climax of the play, the drama," Welch said. "And the medieval setting in which we were sentenced, you know, it was a bit chilling." Welch and his fellow convicts had fallen a long way since pulling off one of the most audacious and lucrative thefts the UK had ever seen: the Great Train Robbery. Welch and his co-defendants were part of a band who held up a Royal Mail night train travelling from Glasgow to London. The robbers had made off with £2.6m in used banknotes, a record haul at that time, and the equivalent of over £50m ($65.8m) today. At the time of Welch's trial, police were still hunting for three of the people they suspected had been involved in the crime. To execute this carefully orchestrated robbery, 15 members of two of London's biggest criminal gangs had worked together, each tasked with a particular role in the plot. "They were regarded as the elite of the criminal world," Reginald Abbiss, who had covered the crime for the BBC as a young reporter, told the Witness History podcast in 2023. "You had to have a certain talent and audacity, certain abilities to be able to pull a heist of this magnitude and they came together because they needed a multitude of talent." The daring robbery took place just after 03:00 on 8 August 1963. The first step the criminals had taken was to cut the phone lines to stop an alarm being raised. They then rigged the train signals to stay red. "They put a glove over the green light, they wired a cheap battery up to the red light and this, of course, meant the driver had to slow up," said Abbiss. Seeing the red light, the train's driver, Jack Mills, stopped the engine, and his co-driver, David Whitby, climbed out to use the trackside phone to find out what the problem was. That's when Whitby discovered that the line had been cut, and he was set upon by masked men wearing boiler suits. In the meantime, a masked robber burst into the train's cab to restrain the driver. When Mills tried to put up a fight, another gang member hit him over the head, rendering him semi-conscious. "The one glitch, if you like, was the fact that the train driver… tried to resist," said Abbiss. "One of the robbers hit him on the head with a cosh. A lot of blood and down he went." The gang had been given inside information that the cash and high-value packages were held in the train's front two coaches. And because it was a Bank Holiday weekend, it would be carrying more money than usual. One hundred and twenty sacks of money Although there weren't any police onboard, there were more than 70 Post Office employees, mostly in the rear carriages, where they were busy sorting letters. The criminals who had already familiarised themselves with the train's operation and layout quickly uncoupled the two money-laden carriages. The plan was to detach them and drive them away from the steep embankment to a predetermined rendezvous where it would be easier to unload the bags of cash. It was then they hit a problem. "They had a driver to drive the train, he couldn't get the train going, and they had to pull the original driver, Jack Mills, up from the floor and threaten him and say, 'Drive the train,'" said Abbiss. "He managed to get the train a mile up the line to where most of the gang were waiting, leaving the other eight or nine coaches with sorters happily sorting, totally unaware that the main part of the train had gone on ahead." Mills, still bleeding profusely, was told to stop the two front carriages at Bridego Bridge. There, the rest of the gang broke into the carriages, overpowering the Post Office staff working in them, and forcing them to lie face down on the floor. They also brought in Mills and Whitby, who were handcuffed together. The gang had decided that they would give themselves just 15 minutes to unload the loot and then leave whatever money was left. They formed a human chain and swiftly removed 120 sacks containing two-and-a-half tonnes of money into parked Land Rovers. After a quarter of an hour, the crew called time and ordered the terrified Post Office staff to stay still and not to attempt to contact the police for 30 minutes. Then the robbers drove off into the night. The boldness of the theft and the enormous sum of money involved captured the British public's imagination. In the weeks that followed, the country was gripped by sensational headlines detailing the police's hunt for the perpetrators. But despite the meticulous nature of the robbery's planning and its skilful execution, within a year the majority of the criminal gang had been rounded up and were facing trial. "Well, at first view, the job was a very well-planned job," ex-Det Supt Malcolm Fewtrell, who led investigations into the heist, told BBC News in 1964. "But in the event, it has been a disaster. They obviously weren't so clever as they thought they were." The judge at their trial did not view the robbers' actions in the "romantic" way some of the public seemed to, saying that it would be "positively evil" if he showed the convicted men any semblance of leniency. Crime and punishment "I remember a shock wave ran through the courtroom when the judge, a man called Lord Justice Edmund Davies, handed down 307 years in the space of half an hour," Abbiss told BBC Witness History in 2023. At the time, the punishments they received for the robbery were some of the harshest in British criminal history, especially since nobody had been killed and no firearms had been used. "I was just numbed, I couldn't think of anything but 30 years. When are we going to get out? We are never going to get out," one of the robbers, Tommy Wisbey, told Man Alive in 1978. "I don't think it really hits you until a couple of days later and you realise what you've got," fellow gang member Gordon Goody said to the BBC. "I mean it was a bit of a joke downstairs, clowning around and all that kind of thing. But deep down, I suppose you were sick." More like this:• The British politician who was caught faking his own death• The true story of The Great Escape• The bizarre siege behind Stockholm Syndrome The reason the judge gave for the severity of the prison terms was the assault on Mills. "Anybody who has seen that nerve-shattered engine driver can have no doubt of the terrifying effect on law-abiding citizens of a concerted assault by armed robbers," said Justice Davies at the trial. Mills never worked again and died in 1970 of leukaemia. His co-driver Whitby died of a heart attack the following year at the age of 34. But there was also a sense, at least among the robbers themselves, that they were being disproportionately punished because the heist had embarrassed the British establishment. One of them, Roy James, said to the BBC in 1978, "At that moment, all the shame that was with me throughout the trial was lifted because I felt that Mr Edmund Davies then used his position as a High Court judge, used the backing of the state for vengeance. He put himself on a par with me and everything that he said I was." "There was a feeling that Justice Davies came down particularly hard for two reasons," said Abbiss. "One was the violence shown against the train driver, and the other was that the establishment, the government, the Post Office and British Rail, the way that they were sort of caught with their pants down. It showed the establishment to be people perhaps who take their eye off the ball." The criminals' notoriety only grew following their sentencing when two of the gang made dramatic escapes from prison. Charles Wilson, who had been the treasurer of the group, broke out of jail just four months after the trial. He was recaptured in Canada after four years on the run and served another 10 years behind bars. Ronnie Biggs escaped from London's Wandsworth Prison, 15 months after his sentencing, using a makeshift rope ladder. He underwent plastic surgery and lived at times in Spain, Australia and Brazil, evading arrest for nearly 40 years. In 2001, he voluntarily returned to the UK for medical treatment and served the rest of his prison sentence. On the run The law would also eventually catch up with the three gang members who didn't stand trial that day. Bruce Reynolds, considered to be the robbery's mastermind, spent five years on the run until he was arrested on his return to England. He was sentenced to 25 years in jail, but ended up serving just 10. His son Nick, who spent his early life on the run with his father in Mexico and Canada, would later have his own link to the outlaw lifestyle when his band Alabama 3's song Woke Up This Morning became the opening theme of The Sopranos TV series. Ronald "Buster" Edwards, who was later played by Genesis singer Phil Collins in a 1988 film, Buster, fled to Mexico following the robbery. He gave himself up in 1966 and was released after serving nine years. James White, who acted as the quartermaster for the robbery, was caught in Kent and sent to prison after three years on the run. He was released in 1975. Despite the lengthy jail time handed down, all the men convicted of the Great Train Robbery would end up being released early. None served more than 13 years for the crime – although many of them would return to prison for different offences in the years that followed. As for the huge haul stolen during the robbery, despite the police in 1964 offering a 10% share for information that would lead them to it, the majority of the money was never recovered. -- For more stories and never-before-published radio scripts to your inbox, sign up to the In History newsletter, while The Essential List delivers a handpicked selection of features and insights twice a week. For more Culture stories from the BBC, follow us on Facebook, X and Instagram.
