The Washington State Hub and Spoke Model to increase access to medication treatment for opioid use disorders
Open accessAbstract
Introduction The federal Opioid State Targeted Response (Opioid STR) grants provided funding to each state to ramp up the range of responses to reverse the ongoing opioid crisis in the U.S. Washington State used these funds to develop and implement an integrated care model to expand access to medication treatment and reduce unmet need for people with opioid use disorders (OUD), regardless of how they enter the treatment system. This paper examines the design, early implementation and results of the Washington State Hub and Spoke Model.Methods Descriptive data were gathered from key informants, document review, and aggregate data reported by hubs and spokes to Washington State's Opioid STR team.Results The Washington State Hub and Spoke Model reflects a flexible approach that incorporates primary care and substance use treatment programs, as well as outreach, referral and social service organizations, and a nurse care manager. Hubs could be any type of program that had the required expertise and capacity to lead their network in medication treatment for OUD, including all three FDA-approved medications. Six hub-spoke networks were funded, with 8 unique agencies on average, and multiple sites. About 150 prescribers are in these networks (25 on average). In the first 18 months, nearly 5000 people were inducted onto OUD medication treatment: 73% on buprenorphine, 19% on methadone, and 9% on naltrexone.Conclusions The Washington State Hub and Spoke Model built on prior approaches to improve the delivery system for OUD medication treatment and support services, by increasing integration of care, ensuring "no wrong door," engaging with community agencies, and supporting providers who are offering medication treatment. It used essential elements from existing integrated care OUD treatment models, but allowed for organic restructuring to meet the population needs within a community. To date, there have been challenges and successes, but with this approach, Washington State has provided medication treatment for OUD to nearly 5000 people. Sustainability efforts are underway. In the face of the ongoing opioid crisis, it remains essential to develop, implement and evaluate novel models, such as Washington's Hub and Spoke approach, to improve treatment access and increase capacity.
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The hub-and-spoke model has been used effectively to expand access to treatment of opioid use disorder.
“An example is the hub- and- spoke model, which has been used effectively to expand access to treatment of opioid use disorder.”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [269]
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- Authors
- Reif, S., Brolin, M. F., Stewart, M. T., Fuchs, T. J., Speaker, E., & Mazel, S. B.
- Affiliations
- Brandeis University (US)
- State of Washington (US)
- Washington Department of Social and Health Services (US)
- Corresponding author
- Reif, Sharon
- Venue
- Journal of Substance Abuse Treatment
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 108
- Pages
- 33-39
- ISSN
- 0740-5472 (ISSN-L)
- PMC
- PMC6893117
- OpenAlex
- W2964346165
- Cited by
- 58
- References
- 34
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 13 · 2023: 10 · 2022: 2 · 2021: 10 · 2020: 5 · 2019: 1
- FWCI
- 4.14
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Substance Abuse Treatment (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Substance Abuse and Mental Health Services Administration
- National Institute on Drug Abuse
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- opioid use disorder, medication-assisted treatment, hub and spoke model, integrated care, buprenorphine, methadone, naltrexone, access to treatment, primary care integration, nursing care management, Washington State
- MeSH terms
- Buprenorphine, Government Programs, Health Services Accessibility, Humans, Narcotic Antagonists, Opioid-Related Disorders, Primary Health Care, Referral and Consultation, State Government, Washington, Opiate Substitution Treatment
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