In the last few years, deadly waves of an opioid epidemic have swept across the United States, hitting rural areas especially hard and leaving millions of impacted lives in its wake.

In a study published in December 2020, UC Berkeley School of Public Health researchers looked into the interventions combating opioid addiction in rural areas by analyzing the implementation of California’s “hub and spoke” model. The model, adopted in 2017 by California state lawmakers, includes specialized treatment programs, or “hubs,” and clinical service providers, or “spokes,” that work in tandem to increase access to medication for opioid addicts. 

The study, led by School of Public Health assistant professor Claire Snell-Rood, found weak relationships between “hubs” and “spokes,” impacted by limited behavioral health resources and large distances in rural California. The study also noted an excessive focus on treatment rather than various factors for holistic health and unintentional favoring of for-profit providers of opioid addiction medications such as methadone.

“By focusing on the nuts and bolt of how implementation planning and how intervention delivery occurs, it’s our goal to really draw attention to and create a road map of how the next generation of system-level interventions can be designed and delivered in a more efficient way,” Snell-Rood said.

Since the model prioritized treatment “above all else,” according to Snell-Rood, it did not place enough emphasis on other factors necessary for the overall health of people suffering from opioid addiction.

Additionally, the fast rollout of the hubs meant that a lot of established clinics in rural areas were unintentionally left out. In contrast, for-profit methadone providers received contracts at six of the seven hubs in rural California.

“There was a really missed opportunity to roll out the system with folks who already had extensive networks on the ground and expertise and as a result, many of the hub-spoke relationships ended up underdeveloped,” Snell-Rood said. “(The relationships) could have been much more robust if different people were selected.”

In particular, the study’s research focused on aspects of the “hub and spoke” model including its contracting process, structures, funding and final states of the treatment programs and service providers.

Snell-Rood noted the critical role that mental health treatment should play alongside substance use treatment in the future. She is currently working on identifying strategies with her research group where individuals can receive mental health services in rural areas from community health workers and peer providers.

“I do think that the fact that this funding from the federal government was designed so narrowly to focus on substance use alone really hobbled the capacity of rural providers to have resources to respond to addiction as it really is — a whole body and whole community issue,” Snell-Rood said. “It’s not a single diagnosis at a time.”