Hub-And-Spoke Opioid Treatment Program Has Grown In 5 Years Since Shumlin Speech

Jan 9, 2019

Vermont’s hub-and-spoke opiate treatment system was only offered at a handful of locations when then-Governor Peter Shumlin devoted his 2014 State of the State speech to the opioid crisis.

But in the five years since the speech, the hub-and-spoke system has expanded across Vermont, and it’s now a model that other states are replicating.

John Brooklyn helped open up the first hub and spoke location in Chittenden County in 2013. He said Shumlin’s speech the following year brought attention to the problem which was already spreading across the state.

Brooklyn said the speech also opened the door for local discussions, and ultimately ways to better address the crisis.

“Once the speech happened many communities, small communities, they began to really think about their community members as people who needed treatment,” Brooklyn said. “And it seemed as though the discussions around keeping people safe, identifying people, getting them to treatment became elevated.”

Today there are nine hub locations and 88 local spokes made up of doctors, nurses and counselors across the state.

The hub-and-spoke system is credited with eliminating wait times for people who want treatment. There are more than 7,000 people in the program.

Since Shumlin’s speech the number of patients receiving the most acute treatment in the hubs has more than doubled.

Jeannie Leavitt, a Brattleboro resident, entered the hub-and-spoke program at the Brattleboro Retreat in 2016 after she became addicted to the pain killers a doctor prescribed for a back injury.

“That drug controlled what I did in my life for fun, or going places with people. You know you get sick of it, day after day,” she said. “And if I got low on pills I’d go through withdrawal, and that is horrible. I mean it was just, it wasn’t fun, at all.”

A sign as the Brattleboro Retreat directs people towards the hub program.
Credit Howard Weiss-Tisman / VPR

Under the hub-and-spoke system patients first enter a hub, where they receive daily services including medication and counseling, until they are well enough to step down to a monthly meeting, or spoke.

Leavitt said while it was hard at first, the sustained support helped her get off percocet.

“When you go into hub, it’s unknown territory for anybody,” she said. “And it’s scary. But I knew I had to do it and do it quick, because everything was going to hell in a handbasket.”

"Once the speech happened many communities, small communities, they began to really think about their community members as people who needed treatment. And it seemed as though the discussions around keeping people safe, identifying people, getting them to treatment became elevated." - Dr. John Brooklyn, addiction specialist

Leavitt is now in the spoke program. She visits the Brattleboro Retreat once a month to continue her treatment, which includes a support session and taking suboxone, the medication that helps patients control their opioid addiction.

“If you’re ready to do it you just have do it," Leavitt said. "You have to have drive to get down there, you know, you do. But once you do it it’s going to be a routine in your life. And it will happen, I mean it will just happen for you.”

Vermont Health Commissioner Mark Levine says the state spends about $50 million to $60 million a year on the hub-and-spoke program.

But Levine noted the state invests significant resources in preventing other dieseases, like asthma or lyme disease.

“The hub-and-spoke model is based on a comprehensive medical care model that calls opioid use disorder another chronic disease,” Levine said. “So it’s worthy of the same kind of financial investment we would provide for any medical disorder. And we’re providing a treatment system that’s comprehensive and integrated enough to do justice to that.”

The expansion of the hub-and-spoke system over the past five years is also credited with helping Vermont limit overdose deaths.

A recent federal report found that Vermont had the lowest overdose death rate among the six New England states.

But at the same time, Vermont experienced a record number of fatal opiate overdoses in 2017, and will likely set a new record once 2018 figures are released. Many deaths are caused by the poweful opiate fentanyl.

“We are in this for the long run, there’s no question,” Levine said. “And having said all of that, fentanyl is still there. It’s causing a much higher proportion, regionally, as well as nationwide, of the opioid overdose deaths. And it’s very hard to get ahead of that when that’s happening exactly at the same time as all of these other successes.”

Levine says the steady growth of the hub-and-spoke program allowed Vermont to get ahead of other states who belatedly took action.

Just this month, New Hampshire rolled out its own hub-and-spoke program based on Vermont’s model.

This is part of a series airing on VPR this week to mark the five-year anniversary of Shumlin's State of the State speech on addiction. Check here for more stories throughout the week.