Assessing Washington State's Models to Increase Use of Medications for Opioid Use Disorder: Hub and Spoke and Low-Barrier Opioid Treatment Networks, 2015-2022

MOUD remains an underutilized evidence-based practice with potential to reduce opioid use disorder (OUD) and save lives. Washington State expanded its Hub & Spoke (H&S) model for OUD medication treatment (MOUD: buprenorphine, methadone, naltrexone) by funding additional networks and developing a low-barrier, Opioid Treatment Network (OTN) model. The Washington H&S model was designed as a flexible approach incorporating primary care and substance use treatment programs, referral organizations, nurse care managers and care navigators. The OTN model offers MOUD induction in non-traditional settings (e.g., emergency departments, jails) with connections to community partners who will offer MOUD maintenance.

This study examined the implementation and effectiveness of the H&S and OTN models for increasing MOUD treatment and improving outcomes for people with OUD. Washington's H&S and OTN interventions were funded through federal STR/SOR opioid response grants, and the expanded H&S networks were funded through the state. The study, Hub and Spoke Opioid Treatment Networks: 2nd Generation Approaches to Improve Medication Treatment for Opioid Use Disorders (R01DA0561067), and its supplement (R01DA0561067S1) was part of NIH's HEAL initiative, and built on an earlier study (R33DA045851). All three studies were supported by the National Institute on Drug Abuse.

Expanding Access to Low-Barrier Opioid Use Disorder Treatment in Non-Traditional Settings: Washington's Opioid Treatment Network

• Increasing utilization of medications that treat opioid use disorders (MOUD) remains an essential strategy to curb the opioid crisis nationwide, especially among rural areas where access can present challenges. Washington State expanded access to MOUD through its opioid treatment networks (OTN), which provide low-barrier access to MOUD in non-traditional settings with an emphasis on buprenorphine and rural locations. The study examined changes in buprenorphine utilization between Medicaid beneficiaries who initiated treatment at OTNs compared to individuals outside OTN facilities and by rural-urban residence.

Differential Changes in Use of Medications for Opioid Use Disorder by Race-Ethnicity: Effects of a Hub-and-Spoke Model

• This study assessed whether delivery of opioid use disorder (OUD) treatment through a hub and spoke (HS) model is associated with better adherence to psychotropic medication treatment, compared to usual treatment. Washington State's HS model required each network to include at least one mental health program, so it was hypothesized that it would improve psychotropic medication adherence for people with both a mental health disorder (MHD) and an OUD.

Treatment for Comorbid Mental Health Disorders Among Patients Treated for Opioid Disorder: The Role of a Hub and Spoke Intervention

• The research team examined, separately for different racial-ethnic groups, whether use of medications for opioid use disorder (MOUD) increased more among people treated in a hub-and-spoke care model than among people treated in a non-hub-and-spoke model.