California tests if addiction treatment can be incorporated into primary care

California had just weeks to get a program that used medication to treat opioid use disorder up and running after receiving $90 million in federal grants in 2017. So officials found a model that was already working in Vermont, and supersized it to fit the sprawling state.

The scaling up of the "Hub and Spoke" system, particularly in rural areas, has presented challenges but also delivered results in locales like this Gold Rush-era city east of Sacramento — and dovetailed with existing efforts to expand medication-assisted treatment to give the state a two-pronged approach to confronting the opioid epidemic.

Hub and Spoke, first launched in Vermont in 2012, features a system of regional addiction treatment centers or "hubs" that are connected with "spokes" like primary care practices and local clinics. Patients have individual treatment plans. The system allows many patients to get help close to home, at clinics that offer buprenorphine, a drug seen as the gold standard for treating opioid abuse symptoms, and that employ behavioral health providers and nurse case managers. Those with more complex cases, who for example need to be treated daily with methadone, can be referred to a centralized hub.