Assessing Washington State's Models to Increase Use of Medications for Opioid Use Disorder: Hub and Spoke and Low-Barrier Opioid Treatment Networks, 2015-2022 (ICPSR 39817)
Version Date: Apr 13, 2026 View help for published
Principal Investigator(s): View help for Principal Investigator(s)
Sharon Reif, Brandeis University
https://doi.org/10.3886/ICPSR39817.v1
Version V1
Summary View help for Summary
MOUD remains an underutilized evidence-based practice with potential to reduce opioid use disorder (OUD) and save lives. Washington State expanded its Hub & Spoke (H&S) model for OUD medication treatment (MOUD: buprenorphine, methadone, naltrexone) by funding additional networks and developing a low-barrier, Opioid Treatment Network (OTN) model. The Washington H&S model was designed as a flexible approach incorporating primary care and substance use treatment programs, referral organizations, nurse care managers and care navigators. The OTN model offers MOUD induction in non-traditional settings (e.g., emergency departments, jails) with connections to community partners who will offer MOUD maintenance.
This study examined the implementation and effectiveness of the H&S and OTN models for increasing MOUD treatment and improving outcomes for people with OUD. Washington's H&S and OTN interventions were funded through federal STR/SOR opioid response grants, and the expanded H&S networks were funded through the state. The study, Hub and Spoke Opioid Treatment Networks: 2nd Generation Approaches to Improve Medication Treatment for Opioid Use Disorders (R01DA0561067), and its supplement (R01DA0561067S1) was part of NIH's HEAL initiative, and built on an earlier study (R33DA045851). All three studies were supported by the National Institute on Drug Abuse.
Expanding Access to Low-Barrier Opioid Use Disorder Treatment in Non-Traditional Settings: Washington's Opioid Treatment Network
- Increasing utilization of medications that treat opioid use disorders (MOUD) remains an essential strategy to curb the opioid crisis nationwide, especially among rural areas where access can present challenges. Washington State expanded access to MOUD through its opioid treatment networks (OTN), which provide low-barrier access to MOUD in non-traditional settings with an emphasis on buprenorphine and rural locations. The study examined changes in buprenorphine utilization between Medicaid beneficiaries who initiated treatment at OTNs compared to individuals outside OTN facilities and by rural-urban residence.
Differential Changes in Use of Medications for Opioid Use Disorder by Race-Ethnicity: Effects of a Hub-and-Spoke Model
- This study assessed whether delivery of opioid use disorder (OUD) treatment through a hub and spoke (HS) model is associated with better adherence to psychotropic medication treatment, compared to usual treatment. Washington State's HS model required each network to include at least one mental health program, so it was hypothesized that it would improve psychotropic medication adherence for people with both a mental health disorder (MHD) and an OUD.
Treatment for Comorbid Mental Health Disorders Among Patients Treated for Opioid Disorder: The Role of a Hub and Spoke Intervention
- The research team examined, separately for different racial-ethnic groups, whether use of medications for opioid use disorder (MOUD) increased more among people treated in a hub-and-spoke care model than among people treated in a non-hub-and-spoke model.
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Data were made available by Washington State to the research team, under a data use agreement that precludes data sharing. The codebooks for the published papers are included in this study, to facilitate replication by researchers with access to the same data or inform future analyses of similar data and research questions.
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This release is a Fast Track Release and files are distributed as they were received from the data depositor. The files have been zipped for release. Users should consult the investigator(s) if further information is needed.
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Expanding Access to Low-Barrier Opioid Use Disorder Treatment in Non-Traditional Settings: Washington's Opioid Treatment Network
- Comparative time-series analyses were used to examine longitudinal patterns of buprenorphine utilization among a sample (n = 93,401) of age 18 to 64 Washington State Medicaid beneficiaries diagnosed with OUD between 2019 and 2022.
- Monthly aggregated rates of buprenorphine utilization, stratified by OTN versus non-OTN and rural-urban residence, were calculated for analysis.
Differential Changes in Use of Medications for Opioid Use Disorder by Race-Ethnicity: Effects of a Hub-and-Spoke Model
- The study sample comprises adult Medicaid beneficiaries who had a diagnosis of depression or bipolar disorder in Washington during 2017-2019, who also received medication treatment for OUD.
- The research team computed rates for receipt of and adherence to relevant psychotropic medication, before and after regression-based adjustment for patient characteristics with propensity score weighting to mitigate potential selection effects. The key exposure was treatment at a HS program.
Treatment for Comorbid Mental Health Disorders Among Patients Treated for Opioid Disorder: The Role of a Hub and Spoke Intervention
- Comparative time-series analyses were performed with Washington State Medicaid claims (2017-2019) data for 115,911 enrollees to investigate MOUD use, stratified by care model and enrollee race-ethnicity.
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- Quantitative analyses relied on Medicaid claims data from July 2016 through December 2022, obtained directly from Washington State.
- The sample frame included adults aged 18-64, who were Medicaid enrollees in Washington and had indication of opioid use disorder in the claims data (e.g., OUD diagnosis; methadone maintenance treatment).
- Enrollees who were dually eligible for Medicaid and Medicare were excluded.
- Washington State provided data to the research team to identify who was an H&S participant and who was an OTN participant. These data were matched to the claims by a unique research identifier.
- The analytic sample included enrollees who were
(1) identified as H&S or OTN after each of these interventions began;
(2) treated in facilities that treated H&S or OTN clients, before each intervention began;
(3) all remaining enrollees as defined above, who served as a comparison group; and
(4) for the funded supplement, the sample focused on (a) people with specific mental disorders; and (b) people with other substance use disorders.
Universe View help for Universe
All adults aged 18-64, who are Medicaid enrollees in Washington State, with opioid use disorder as indicated in claims data.
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This study is maintained and distributed by the National Addiction and Health Data Archive Program (NAHDAP). NAHDAP is supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH).