Assessment of Medication for Opioid Use Disorder as Delivered within the Vermont Hub and Spoke System

This innovative, early program profile examines the Vermont “Hub-and-Spoke” system which provides medication to those with opioid use disorders. A questionnaire was completed with 100 people who were either receiving methadone treatment in a “hub,” buprenorphine treatment in a “spoke,” or were not currently in treatment. Although it wasn’t a requirement to be in the study, criminal justice involvement was one area of functioning measured in the questionnaire. The findings showed that receiving treatment through a “hub” or “spoke” led to a decrease in drug use and improved functioning across several life areas.

In response to the opioid crisis, Vermont developed a new treatment system to provide medication-assisted treatment called the “Hub-and-Spoke” system. “Hubs” consist of licensed opioid treatment programs that can dispense medication and provide extensive support. “Spokes” are primary care settings that can provide buprenorphine for opioid use disorders.  Individuals with greater clinical complexity are treated in “hubs.”

To compare and contrast those treated in “hubs” with those treated in “spokes”, 100 people were surveyed: 40 receiving methadone in a “hub,” 40 receiving buprenorphine is a “spoke,” and 20 individuals who were no longer receiving or had never received medication-assisted treatment. Survey information was collected at two time points. Those receiving treatment were asked about the 90 days prior to the interview and the 90 days prior to entering treatment. Those not in treatment were asked about the 90 days prior to the interview and the 90 day period 12 months before the interview.

There were not many differences between those receiving treatment in “hubs” and those receiving treatment in “spokes.” However, although both groups rated the effectiveness of their substance use treatment very highly, those in “spokes” rated their overall treatment effectiveness and the health, personal responsibility, and community membership improvement domains significantly higher.

The participants who were not receiving treatment did not show any statistically significant improvements in any areas of functioning between time 1 and time 2. However, those in treatment showed significant improvements in most areas of functioning and substance use including overdoses, visits to the emergency room, illegal activities, police contacts, and family conflict. They also reported a 96% decrease in the number of days that they used opioids from time 1 to time 2.

Article Citation:

Rawson, R., Cousins, S.J., McCann, M., Pearce, R. & Van Donsel, A. (2019). Assessment of medication for opioid use disorder as delivered within the Vermont hub and spoke system. Journal of Substance Use Treatment, 97, 84-90.

Contact Information for the Author:

Richard Rawson, Center for Behavior and Health, Department of Psychiatry, University of Vermont, 1952 Rte 73, Brandon, VT 05733.
E-mail: [email protected]