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Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder

Development, Implementation, and Impact

Brooklyn, John R., MD; Sigmon, Stacey C., PhD

doi: 10.1097/ADM.0000000000000310
Original Research

Background: Opioid use disorders (OUDs) are reaching epidemic proportions in the United States, and many geographic areas struggle with a persistent shortage in availability of opioid agonist treatment. Over the past 5 years, Vermont addiction medicine physicians and public health leaders have responded to these challenges by developing an integrated hub-and-spoke opioid treatment network.

Methods: In the present report, we review the development, implementation, and impact of this novel hub-and-spoke model for expanding OUD treatment in Vermont.

Results: Vermont's hub-and-spoke system has been implemented state-wide and well-received by providers and patients alike. Adoption of this model has been associated with substantial increases in the state's OUD treatment capacity, with Vermont now having the highest capacity for treating OUD in the United States with 10.56 people in treatment per 1000. There has been a 64% increase in physicians waivered to prescribe buprenorphine, a 50% increase in patients served per waivered physician, and a robust bidirectional transfer of patients between hubs and spokes based upon clinical need. Challenges to system implementation and important future directions are discussed.

Conclusions: Development and implementation of a hub-and-spoke system of care has contributed substantially to improvements in opioid agonist treatment capacity in Vermont. This system may serve as a model for other states grappling with the current opioid use epidemic.

Department of Psychiatry (JRB, SCS); Department of Psychology (SCS), University of Vermont, Burlington, VT.

Send correspondence to John R. Brooklyn, MD, University of Vermont, UHC-SATC, 1 South Prospect Street, Room 1420, Burlington, VT 05401. E-mail:

Received 4 October, 2016

Accepted 15 February, 2017

Author contributions: J.R.B. conceptualized and developed the manuscript. S.C.S. contributed content and made revisions to the manuscript. Both authors have reviewed and contributed to the study manuscript and approve of the final article.

Funding: Supported in part by National Institutes of Health research grant (R34DA037385), and also a National Institute of General Medical Sciences center grant (P20GM103644).

Conflicts of interest: There are no financial disclosures relevant to this study.

© 2017 American Society of Addiction Medicine