N.H. Providers Look to Vermont For Advice on Rolling Out New Addiction Treatment System

Jan 25, 2019

State health officials say New Hampshire's new system for addiction treatment will be a game changer in terms of people’s ability to access information and care, especially around problems with opioid use.

But the system, known as The Doorway, is only a few weeks old, and treatment providers are still trying to figure out how all the logistics will work. As NHPR's Britta Greene reports, they're turning to their counterparts in Vermont for advice. 

Editor’s note: We recommend listening to this story.

The trip from Concord to Burlington is two and half hours on a good day, but when a group from Riverbend Community Mental Health made the trek earlier this week, the roads were covered with snow and ice.

They pulled into Vermont’s largest city just in time for their morning appointment, the first in day-long tour of addiction treatment centers in the area.

Meeting them was John Brooklyn, a physician well known for his work treating substance use disorders.

Brooklyn is behind a concept known as “hub and spoke,” a system where different providers collaborate to care for patients struggling with complex addictions.

Vermont launched its hub-and-spoke system about five years ago, while New Hampshire's just got off the ground January 1.

This group from Riverbend is tasked with implementing the program in Concord, and is interested in learning best practices from Vermont.

In conversation with Brooklyn and his colleagues, they quickly observe there's major differences between the two states' hub-and-spoke models, the biggest one being structural. 

In Vermont, the “hub” is a treatment center offering high-intensity specialty care for patients. That includes daily appointments to dispense medication for opioid addiction. The "spokes" treat patients farther along in their recovery. 

In New Hampshire’s system, the "hub" is more of a referral and tracking center, evaluating patients for their needs and sending them elsewhere for treatment.  

“It’s very interesting to see how they’ve done it, and see how we can incorporate it. My wheels are already spinning!” said Shanna Large, Riverbend’s director of substance use disorders.

One big takeaway for the group is the idea of having a regular “triage” meeting with local providers, where they can match patients to the most appropriate treatment. Providers in Vermont say these meetings have also been helpful to coordinate logistics as their system has evolved over time.

“I think what we’re learning a lot about is how to support each other and make sure that clients get expedited into services as quickly as possible,” said Sarah Gagnon, vice president of clinical operations.

Still, Gagnon and her colleagues say there's simply fewer doctors willing to treat patients with opoioid use disorders in the Concord area, making connecting patients with care more difficult. Plus, the hubs in New Hampshire are required to collect a lot more data, which they say can be burdensome for both providers and patients.

"I think what we are learning a lot about is how to support each other and make sure that clients get expedited into services as quickly as possible."

“I think there are certainly some challenges, so it’s hard to say exactly how it’ll all land,” said Keri Height, a psychologist with Dartmouth Hitchcock who is studying Vermont’s hub and spoke system.  New Hampshire's program is likely to evolve over time, she said. 

Data she and her team have collected from Vermont show the hub-and-spoke system there has been successful. 

“Use of illegal opioids does significantly decrease,” she said, “injection drug use significantly decreases, scores on measures of depression and anxiety significantly decrease.”

There are worrisome areas, too, though. The Vermont system doesn’t seem to be making a significant dent in cocaine use, for example, and rates of PTSD remain troublingly high for certain subsets of their clientele.

Still, the team from Concord is optimistic they’ll be able to take the lessons they learned in Burlington and build the best system they can, on the other side of the border.