Rawson Study Demonstrates Hub & Spoke Model Impact on Opioid Addiction

January 25, 2018 by Jennifer Nachbur

Richard Rawson, Ph.D., UVM Professor of Psychiatry

An evaluation of Vermont’s Hub and Spoke system of care led by University of Vermont Research Professor of Psychiatry Richard Rawson, Ph.D., shows that people in treatment for opioid addiction reported a 96 percent decrease in opioid use and a 100 percent drop in overdose incidences. 

The 185-page report from the Vermont Department of Health outlines the findings of the study, which was conducted in 2017 to evaluate the impact of the model on those in treatment, and their families.

The work by Rawson, who is an investigator in the Vermont Center on Behavior and Health at UVM, was supported by a $199,200 grant from the Vermont Department of Health made possible through $150,000 in funding from the Centers for Disease Control and Prevention, and $49,200 in funding from Substance Abuse and Mental Health Services Administration (SAMHSA).

The evaluation found that, while there is still a great deal more to do to address opioid addiction and substance use disorder in Vermont, the four-year-old Hub and Spoke system has made a significant positive impact, according to many important personal and public health and safety indicators.

“This report gives me hope,” said Mark Levine, M.D., Vermont Commissioner of Health and a professor of medicine at UVM. “All across the country, our friends, neighbors and communities are struggling against the toll brought about by addictive, and all-too-plentiful, illicit drugs. By reviewing the data, and listening to the people who are working hard to recover, we see that our Hub and Spoke system is beginning to bend the curve against the opioid epidemic.”

Vermont’s Hub and Spoke system of care focuses on medication-assisted treatment (MAT) – either methadone or buprenorphine -- administered at one of the state’s six regional treatment centers (Hubs) and in physician offices (Spokes). This approach has been shown to be the most effective treatment for people with opioid use disorders. People who are addicted to opioids suffer painful withdrawal when they stop using, and powerful cravings even after withdrawal has ended.

Key findings among Hub and Spoke system study participants:

• 96% decrease in opioid use.
• 92% drop in injection drug use.
• Statistically significant reductions in the use of alcohol and illicit drugs — except cannabis/marijuana, which stayed relatively unchanged. People who were not in treatment reported no significant changes in any measure.
• 89% decrease in emergency department visits.
• 90% reduction in both illegal activities and police stops/arrests.
• Zero participants in treatment had overdosed in the 90 days leading up to the study interview, compared to 25% who had overdosed in the 90 days before entering treatment.
• Family conflict, feelings of depression, anxiety and anger decreased, and participants reported being much more satisfied with their lives.

The report also provides recommendations for continued improvement of the care system, many of which are already the focus of state policy makers, including Governor Scott’s Opioid Coordination Council, which last month issued its strategic recommendations. This new report points out the need for ensuring both Hub and Spoke services are adequately available in all regions of the state, and the need for greater emphasis on integrating mental health services into the system, as well as help for people in treatment to find employment and housing.

“There is no question that Vermont’s comprehensive approach to addressing drug addiction and substance abuse disorder has saved hundreds of lives,” said Levine. “I’m encouraged with how far we have come in just a few years, and pleased that our Hub and Spoke system is a national model for access to effective treatment, when and where needed. But we have much left to do,” Dr. Levine said. “Every overdose death is one too many. We can’t stop until we ensure everyone can get the treatment they need, and that people don’t set foot on the road that can lead to the tragedy of addiction.”

Read the Hub and Spoke evaluation summary brief and full report.

(This article has been adapted from a press release produced by the Vermont Department of Health.)