The Hub & Spoke System for Treatment of Opioid Use Disorders

Background for Researchers and Policy Makers

Over the past few years, the state of Vermont has developed an innovative approach to delivering medication-assisted treatment to residents who suffer from opioid addiction. The “Hub & Spoke System” has shown promising initial results and warrants a full, independent assessment of both its effectiveness and potential applicability in other states.

That the nation is experiencing an epidemic of opioid abuse and overdoses have become obvious to even casual observers of the state of health in America. Special programs train journalists to cover the issue (National Press Foundation, 2016a, 2016b), and Congress has taken up legislation, albeit with mixed results (Kansas City Star, 2016).

The rate of addiction and overdose has grown tremendously in the past 15 years. From 2000 to 2014, the number of opioid overdose deaths per 100,000 more than tripled (Rudd, 2016). About 30,000 people died from overdose in 2014. That is only a fraction of the estimated 2.5 million people who had substance use disorder involved prescription pain killers or heroin (SAMHSA, 2015). OUD and other substance use disorders also are critically intertwined with a comorbid conditions including depression, HIV infections and complications related to chronic illness.

This epidemic has profound medical, social and financial costs. The human toll is self-evident, and the social impacts are far-reaching including crime, lost productivity and damaged families. The financial toll is difficult to capture fully, but it is on the order of tens of billions of dollars. No recent comprehensive tally exists, but estimates developed as OUD prevalence was increasing rapidly placed the cost at $55.7 billion annually (Bimbaum, 2011). Another analysis estimated $72.5 billion annual costs to insurance companies caused by nonmedical use of opioid pain relievers (CAIF, 2007).

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