The hubs—OTPs—treat patients who have been assessed as needing the OTP level of care. These patients are given methadone, buprenorphine, or naltrexone. Patients in the spokes—physicians’ offices—are given buprenorphine or naltrexone.
The study findings are in a 185-page report completed by Richard A. Rawson, PhD, a research professor with the Vermont Center on Behavior and Health, University of Vermont. Funding came from three sources: a $199,200 grant from the Vermont Department of Health; $150,000 from the federal Centers for Disease Control and Prevention; and $49,200 from the Substance Abuse and Mental Health Services Administration.
Vermont’s hub and spoke system is called the Care Alliance for Opioid Addiction.
The 96% decrease represented a drop in average days of opioid use, from 86 to only 3. The study included 100 opioid users; 80 in treatment and 20 out of treatment.
“This report gives me hope,” said Mark Levine, MD, Vermont’s health commissioner. “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.”
Key findings among Hub-and-Spoke system study participants:
- 96% decrease in opioid use
- 92% drop in injection drug use
- Statistically significant reductions in use of alcohol and illicit drugs (except cannabis/marijuana [relatively unchanged]); in contrast, people not in treatment reported no significant changes in any measure
- 89% decrease in emergency department visits
- 90% reduction in illegal activities and police stops/arrests
No treatment participants had overdosed in the 90 days before the study interview. In contrast, 25% had overdosed in the 90 days before entering treatment. Other findings: family conflict had lessened, and feelings of depression, anxiety, and anger had decreased. Patients reported being much more satisfied with their lives.
For the hub-and-spoke report, go to: http://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP_Hub_and_Spoke_Evaluation_2017_1.pdf.
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