California’s Answer To The Opioid Crisis

California’s Answer To The Opioid Crisis
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While the opioid epidemic has ravaged the East Coast and Appalachia, on the West Coast, California has not escaped the blight of heroin overdose deaths, especially in its smaller counties. The most unfortunate of these, Plumas, Lake, and Tuolumne Counties, sit nestled in the gorgeous scenery of the Sierra Nevada Mountains, Clear Lake, and Yosemite National Park.

California Opioid Overdose Deaths in 2015
California Department of Public Health

California Opioid Overdose Deaths in 2015

Armed with a $90 million federal grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), the California Department of Health Care Services (DHCS) has developed a strategy to tackle the opioid crisis using a model that has shown success in other states.

In Vermont, the expansion of medication-assisted treatment (MAT) to Medicaid beneficiaries through a Hub and Spoke Model has curbed the rate of overdose deaths compared to its neighbor, New Hampshire, which has been slower to adopt MAT coverage. John Brooklyn, M.D., at The University of Vermont Health Network was instrumental in developing Vermont’s program, with a description published in the latest issue of the journal Addiction. "The Hub and Spoke System has allowed Vermont to have almost universal access to MAT with more on MAT per capita than any other state and provides a safety net to prevent loss of treatment by referring to higher or lower levels of care."

This California Hub and Spoke System will be a network of 19 hubs, each with their own spokes. California has boldly set a goal to provide treatment for 20,000 additional people over the next two years.

The Hub and Spoke Model employs Opioid Treatment Programs (OTP), commonly called “methadone clinics,” to serve at the nexus of the system. OTPs not only utilize methadone in opioid treatment, but also buprenorphine, better known under its trade name, Suboxone. MAT is by far the most effective treatment for opioid addiction, with reductions in related overdose deaths, but a heavy stigma persists, especially for methadone. The State of California recognizes the importance of these medications for opioid treatment and has embraced them, regardless of stigma.

The California Hub and Spoke System will expand medication-assisted treatment (MAT), reaching at least 20,000 additional people suffering from opioid addiction.

Heading California’s strategy for the substance use disorder (SUD) crisis is Marlies Perez, SUD Division Chief at DHCS. Ms. Perez comments, “Expanding MAT services through California’s new Hub and Spoke System is expected to have a significant impact on individuals achieving long-term recovery from an opioid use disorder, particularly in rural and tribal communities, where access to MAT has been limited and overdose rates are rising.”

The 19 Hub locations are separate organizations, such as the Los Angeles nonprofit, Matrix Institute. “Matrix Institute is honored to have been selected as one of two providers in Los Angeles County, tasked to create a Hub and Spoke system to address the opioid epidemic plaguing California and the rest of the United States. We are excited and eager to join the statewide effort in educating local communities regarding opioid use disorders and improving access to medication-assisted treatment,” states Dan George, Director of Operations.

This new system is a collaboration that includes many of the large addiction organizations in the state, including the California Society of Addiction Medicine (CSAM). Jean Marsters, MD, Chair of the CSAM’s Committee on Education says, “CSAM is honored to be a coalition partner in this grant… increasing the number of people receiving treatment by 20,000 over the next two years.” Dr. Marsters explains further, “CSAM will help create a foundation for sustainable treatment programs by providing training and mentorship of healthcare providers by addiction medicine specialists, by working to overcome barriers to care, and by updating guidelines that will inform providers on treatment protocols consistent with current State and Federal regulations.”

This project is projected to be sustainable by shifting payors from SAMHSA grant funding to Medi-Cal and other public systems by the end of the 2-year term.

While the goals of this project may seem audacious, California’s Hub and Spoke System promises to be more than just an expensive experiment. With the proven efficacy of both MAT and the Hub and Spoke model, there is reason to be optimistic that this new program will save many lives.

For those seeking opioid use disorder treatment, the SAMHSA Treatment Locator is a helpful resource.

Click Here for SAMHSA Treatment Locator
US Department of Health and Human Services

Click Here for SAMHSA Treatment Locator

Article updated August 14, 2017 with comments from Dr. John Brooklyn and link to his latest publication in the journal Addiction.

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