# Hub and Spoke Model to Improve Pharmacotherapy Use for Opioid Addiction and Promote Recovery

> **NIH NIH R33** · BRANDEIS UNIVERSITY · 2020 · $694,863

## Abstract

The federal government, through SAMHSA’s Opioid State Targeted Response (Opioid-STR) grants, has
provided funding to each state to ramp up the range of responses in hopes of reversing the ongoing opioid
crisis. Pharmacotherapy to address opioid use disorders (OUDs) is an evidence-based practice although it is
clearly underutilized, especially by primary care providers. Washington State is implementing a “Hub & Spoke”
(H&S) integrated care model to expand access to pharmacotherapy services (also known as medicationassisted
treatment or MAT) and reduce unmet need for people with OUDs regardless of how or where clients
enter the treatment system. This proposed R21/R33 study will take a hybrid effectiveness-implementation
approach, with both implementation evaluation and effectiveness as primary goals. It is essential to understand
how the H&S model is implemented to understand if, how, and why it is an effective approach to treat OUDs.
The specific aims for the proposed study are as follows. R21 PHASE – Early Implementation and
Feasibility: (1) Confirm the feasibility of collecting client and program data from hubs, spokes and comparison
groups; collect baseline data; and confirm data linkages with other key databases; (2) Finalize elements
needed for R33 effectiveness study, including comparison groups, dependent variables, and key analytic
subgroups; (3) Assess the early implementation of the H&S model. R33 PHASE – Effectiveness: (1) Test
whether the H&S model is effective for addressing OUDs; (2) Determine whether people with OUDs treated in
the H&S model have better outcomes if they receive pharmacotherapy + counseling versus only
pharmacotherapy. (3) Test whether the H&S model is differentially effective for subgroups (e.g., age, gender,
OUD type, mental disorder, rural); (4) Examine, using mixed methods, implementation of the H&S model and
how specific aspects across and within each hub-spoke network relate to the overall effectiveness.
This study will focus primarily on adults (18+) with OUDs in Washington who are enrolled in Medicaid,
about 90% of people with OUDs in treatment in Washington. Effectiveness measure include a range of
structure, outcome and process measures at client- and system-levels, including drug use, overdose, access
to pharmacotherapy, and arrests, incarceration and employment. Washington is a leader in addiction treatment
services and detailed, linkable data systems. Statistical methods will be used to ensure a rigorous quasiexperimental
design. The findings from this study will enable us to understand the essential elements of the
H&S model for the most effective treatment for OUDs, and how to bring more primary care providers to the
addiction pharmacotherapy practice. It will serve as a model for other states and systems, offering a flexible
approach that addresses many existing barriers to the use of pharmacotherapy for people with OUDs, ensuring
that there is no wrong door to enter treatment and that people with OUD...

## Key facts

- **NIH application ID:** 9998943
- **Project number:** 5R33DA045851-04
- **Recipient organization:** BRANDEIS UNIVERSITY
- **Principal Investigator:** SHARON REIF
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $694,863
- **Award type:** 5
- **Project period:** 2017-09-15 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9998943

## Citation

> US National Institutes of Health, RePORTER application 9998943, Hub and Spoke Model to Improve Pharmacotherapy Use for Opioid Addiction and Promote Recovery (5R33DA045851-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9998943. Licensed CC0.

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