California continues to expand its efforts to combat the opioid addiction crisis with a boost of federal funding and a program model from an unlikely East Coast source.
The latest component of the state’s medication assisted treatment plan for opioid addiction is called the Hub and Spoke System, which is based on a similar, highly successful program in Vermont that was started in 2012. Hub and Spoke, made possible by more than $200 million in federal grants and overseen by the Department of Health Care Services (DHCS), furthers state efforts to treat opioid abuse (particularly overdoses) as a chronic disease and uses a treatment model similar to that of primary medical care.
Hub and Spoke is a system of regional addiction treatment centers (“hubs”) throughout the state connected by “spokes” such as primary care practices and local clinics that are capable of prescribing buprenorphine—considered the best option for treating opioid abuse symptoms. With 19 hubs and more than 200 spokes, patients receive individual treatment plans and access to a registered nurse and a licensed clinical social worker.
In 2017, about 1,900 people in California died from an opioid overdose. Although California’s overall overdose death rate is below the national average, several rural counties have rates that exceed the national average, according to DHCS.
Regional hubs are responsible for high-intensity medication assisted treatment, with the option of prescribing methadone. All staff specialize in addictions treatment, and they provide consultation and training for staff at spokes when necessary.
Spokes are community-based, using maintenance medication assisted treatment, often with buprenorphine and naltrexone. They are the lead providers of care, with a nurse and counselor on staff for patients. Some patients with complex needs are referred to the centralized hub.
The eventual overarching goal is to create a statewide framework for treating a range of addiction disorders, including alcohol, methamphetamines, and other substances, according to DHCS. Integrating care services in urban areas is also a future goal.