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J Subst Abuse Treat. 2020 Jan;108:20-25. doi: 10.1016/j.jsat.2019.07.013. Epub 2019 Jul 27.

Implementation of the hub and spoke model for opioid use disorders in California: Rationale, design and anticipated impact.

Author information

1
University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America. Electronic address: gmiele@mednet.ucla.edu.
2
Stanford University School of Medicine, 1520 Page Mill Road, MC 5265, Palo Alto, CA 94304, United States of America. Electronic address: lauren.caton@stanford.edu.
3
University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America. Electronic address: tfreese@mednet.ucla.edu.
4
Stanford University School of Medicine, 1520 Page Mill Road, MC 5265, Palo Alto, CA 94304, United States of America. Electronic address: mpmcg@stanford.edu.
5
University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America. Electronic address: kdarfler@mednet.ucla.edu.
6
University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America. Electronic address: vpearce@mednet.ucla.edu.
7
California Department of Health Care Services, 1500 Capitol Ave, Sacramento, CA 95814, United States of America. Electronic address: marlies.perez@dhcs.ca.gov.
8
University of California, Los Angeles Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; David Geffen School of Medicine at UCLA, 11075 Santa Monica Blvd., #200, Los Angeles, CA 90025, United States of America; Center for Behavior and Health, University of Vermont, 1 So Prospect Street, Burlington, VT 05405, United States of America. Electronic address: rrawson@mednet.ucla.edu.

Abstract

As part of the State Targeted Response to the opioid epidemic, California has adopted the Hub and Spoke model to expand access to medications for opioid use disorder, particularly buprenorphine, throughout the state. By aligning opioid treatment programs as hubs with primary care, office-based practitioners, and other health care settings as spokes, a broader treatment model can reach more people with opioid use disorder, improve access to medications for opioid use disorders, and decrease overdose deaths. Expanding access requires expanding knowledge and intensive implementation support of new practices. This paper describes the rationale, specific activities and anticipated impact of the implementation plan in California's Hub and Spoke system. Training and technical assistance are designed to: increase the number and capacity of waivered prescribers; enhance skills of prescribers and multidisciplinary teams; and create systems change. Activities include buprenorphine waiver trainings and provider support, a practice facilitator program, Project ECHO sessions, webinars, clinical skills trainings, and regional learning collaboratives. This overview highlights the steps California is taking to build treatment capacity to address the opioid epidemic.

KEYWORDS:

Buprenorphine; California state targeted response; Implementation; Opioid epidemic; Opioid use disorder treatment

PMID:
31399272
PMCID:
PMC6893120
[Available on 2021-01-01]
DOI:
10.1016/j.jsat.2019.07.013

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