A model of addiction care where opioid patients are sent first to regional “hubs” for immediate, comprehensive treatment, then referred to community-based “spokes” such as primary care doctors or local medication providers for follow-up care, is showing marked success and beginning to spread.
Maine legislators recently gave preliminary approval to a statewide “hub and spoke” plan. Similar plans have been adopted in California, Massachusetts, Rhode Island, and Vermont. A similar citywide plan exists in Baltimore.
The Vermont program has shown enormous success. It replaced a “silo” system of local buprenorphine providers that was plagued by logistical and access issues, reimbursement problems for doctors, a lack of support for doctors managing complex cases, and very long waitlists.
Today, Vermont has the highest capacity for treating opioid patients of any state in the union, according to a 2017 study in the Journal of Addiction Medicine.