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Improving treatment for opioid users in rural areas

A new study from researchers at UC Berkeley’s School of Public Health measures the implementation and success of the “hub and spoke model,” a systems-level intervention used to increase access to medication for opioid use disorders (MOUD) in rural areas in the state of California.

Although the hub and spoke model is promising, the analysis, published in the journal Substance Abuse, found that care was restricted in rural areas by limited resources and general distrust within communities.

In order to expand medication-assisted treatment to rural populations, California state lawmakers adopted the hub and spoke model in 2017. This model includes “hubs” for acute care and “spokes” for less complex addiction issues. The hubs are dedicated narcotics treatment programs, while the spokes are clinical service providers at which a buprenorphine or methadone prescriber is available, including community clinics, mental health centers, and federally qualified health centers. Buprenorphine and methadone are both medications used in substitution treatment of patients who are addicted to opioids. The hubs and spokes can work together or independently.

“We found that relationships between hubs and spokes to facilitate the care continuum for rural people who use opioids were restricted by distrust generated through the contracting process, limited behavioral health resources, varied needs, and the large distances characterizing rural California,” said Claire Snell-Rood, the study’s lead author and assistant professor at Berkeley Public Health.

Implementing the hub and spoke model in rural areas comes with other obstacles, including provider shortages, weak relationships between hubs and spokes, and some stigma among buprenorphine providers as contracts to serve rural communities were awarded solely to for-profit methadone providers.

“Of the estimated two million Americans suffering from opioid use disorders, low-income rural residents face the most extensive barriers to accessing treatment,” Snell-Rood said. “As the opioid epidemic evolves with increased poly-substance use like methamphetamine in rural areas, policy-makers and public health practitioners can use this research to guide their scale-up of evidence-based treatments for methamphetamines.”