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Vermont Hub and Spoke Model of Care for OUD

State-wide treatment provision model that has been associated with increased opioid use disorder treatment capacity

Hub and Spoke, implemented by the Vermont Center of Behavior and Health, is Vermont’s system for providing medications for opioid use disorder (MOUD), supporting people in recovery from opioid use disorder (OUD).

Nine regional Hubs offer daily support for patients with complex addictions. At over 75 local Spokes, doctors, nurses, and counselors offer ongoing OUD treatment fully integrated with general healthcare and wellness services. This framework deploys OUD expertise and helps expand access to OUD treatment for Vermonters.

Hubs are opioid treatment programs, with expanded services and strong connections to area Spokes. Each Hub is the source for its area’s most intensive OUD treatment options, provided by highly experienced staff. Spokes are office-based opioid treatment settings, located in communities across Vermont. At many Spokes, OUD treatment is integrated into general medical care, like treatment for other chronic diseases.

Success of the program model can be seen in this presentation. 

Vermont now has the highest capacity for treating OUD in the United States

Continuum of Care
Treatment
Type of Evidence
Peer-reviewed
Replicated
Response Approach
Medications for Opioid Use Disorder
Peer-reviewed Article
Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact
Assessment of medication for opioid use disorder as delivered within the Vermont hub and spoke system
Related Resources
Medications for Opioid Use Disorder Save Lives
Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings
Medication-Assisted Treatment With Methadone: Assessing the Evidence
Medication-Assisted Treatment With Buprenorphine: Assessing the Evidence
Routes of Non-Traditional Entry into Buprenorphine Treatment Programs
Barriers to primary care physicians prescribing buprenorphine
Primary Care: On the Front Lines of the Opioid Epidemic
Primary Care–Based Models for the Treatment of Opioid Use Disorder: A Scoping Review
Review of State Strategies to Expand Medication Assisted Treatment
The Fentanyl Epidemic: State Initiatives to Reduce Overdose Deaths
Aligning City, County and State Resources to Address the Opioid Epidemic: Lessons Learned and Future Opportunities

Evidence of Program Effectiveness

“Vermont’s hub-and-spoke system has been implemented state-wide and well-received by providers and patients alike. Adoption of this model has been associated with substantial increases in the state’s OUD treatment capacity, with Vermont now having the highest capacity for treating OUD in the United States with 10.56 people in treatment per 1000. There has been a 64% increase in physicians waivered to prescribe buprenorphine, a 50% increase in patients served per waivered physician, and a robust bidirectional transfer of patients between hubs and spokes based upon clinical need. Challenges to system implementation and important future directions are discussed.” (Brooklyn and Sigmon, 2017)

In addition to increasing OUD treatment capacity, an evaluation of the program, using patient reported measures, showed a 96% decrease in opioid use, including a 92% drop in injection drug use. There was also a self-reported 89% decrease in emergency department visits, 90% reductions in both illegal activities and police stops/arrests, and zero of the patients studied had overdosed in the 90 days before the interview, compared to 25% who had overdosed before entering treatment. Patients also reported a statistically significant decrease in alcohol and drug use and improved well-being. Patients still cited a need for wrap-around services.