Assessment of medication for opioid use disorder as delivered within the Vermont hub and spoke system

Opioid overdose deaths in the United States have risen dramatically in the past decade. In response to this public health crisis, Vermont created an innovative system called the "hub-and-spoke" (H & S) system, initiated in January 2013. The H & S system has 7 regional "hubs" that offer methadone and buprenorphine, as well as intensive support, and 77 local "spokes" (primary care settings) that offer buprenorphine (and naltrexone to a much lesser extent). Questionnaires were administered to 80 participants in the H & S system (stratified by geographic region, treatment site, and gender) and 20 participants with opioid use disorder not currently in treatment. Data included demographics, drug and alcohol use; opioid use; injection use; education/employment; criminal justice involvement; family and relationship functioning; health and healthcare utilization; multiple areas of mental health functioning; opioid overdose; satisfaction with life areas; stigma; and perceived treatment effectiveness. In-treatment group participants reported use and functioning for the 90 days prior to the date of the interview (T₂) and, retrospectively, a comparable 90-day period prior to treatment entry (T₁). Out-of-treatment group participants were queried about functioning at the time of the interview (T₂) and 12 months earlier (T₁). Individuals not in treatment showed no meaningful changes in any domain from T₁ to T₂. Conversely, participants currently in treatment in the H & S system showed large reductions in substance use, overdoses, emergency department visits, police contacts, and family conflict, and improvements in mood and satisfaction with all areas of life, except work/school participation. Additionally, 85% of in-treatment participants reported 90-day abstinence from opioid use compared to 0% of out-of-treatment participants at T₂. These findings illustrate that medication for opioid use disorders, as delivered in the H & S system in Vermont, is highly effective for reducing opioid use and overdose and improving functioning in many life domains.