Could WA’s health ‘hub’ model treating opioid addiction go nationwide?

Imagine if anyone with an opioid addiction could walk into a local treatment center and receive medication for their addiction, primary care, emotional counseling and many more health and social services — all for free without an appointment.

That’s the promise of the “health engagement hub.” It’s a model credited to Caleb Banta-Green, a research professor in the School of Medicine at the University of Washington. Banta-Green emphasizes he developed it with the help of other researchers, advocates and policymakers.

The hub model has shown signs of success in Washington, including a 68% reduction in overdose mortality rates among around 800 participants, according to preliminary data from the University of Washington. The Legislature funded two hubs in the state last year and spent $3 million in opioid settlement funds this year to establish another three.

Now, Washington U.S. Sen. Maria Cantwell, a Democrat, wants to take the concept nationwide.

Cantwell, alongside Republican U.S. Sen. Bill Cassidy of Louisiana, introduced the Fatal Overdose Reduction Act in May. The legislation would allow existing centers to apply and receive a “Health Engagement Hub” certification, as long as they meet qualifications ensuring drop-in services, no payment requirements and a comprehensive array of treatment services.

With the certification, hubs would receive enhanced Medicaid payments. The legislation also offers planning grants to states that want to establish their own health engagement hubs.

“Access to treatment must be easier than access to fentanyl,” Cantwell said in a statement.

Health engagement hubs

Cantwell said she introduced the legislation after conducting a listening tour across the state to understand the fentanyl epidemic. “We heard everywhere we went that people want treatment, instead of the emergency room or jail,” Cantwell told the Standard, adding that Banta-Green participated in one of the roundtables.

In 2021, only one in five American adults with opioid-use disorder received medications to treat it, according to a joint National Institutes of Health and Centers for Disease Control and Prevention study. That’s despite widespread acknowledgment that medication is the “gold standard” of treatment for opioid-use disorder.

“We’re never going to get to the end of this problem until we expand both the locations of resources for this patient population and until we start finding ways to make treatment much more tenable,” said Everett Maroon, executive director at Blue Mountain Heart to Heart, an organization in Walla Walla that will launch its health engagement hub in September.

The ethos of a health engagement hub is a “no wrong door” approach to addiction treatment. People seeking support are often forced to navigate complex systems, find themselves falling through gaps or are told they’ve been “knocking on the wrong door” all along.

Health engagement hubs aim to streamline the whole process and make it easier for people to receive treatment – meeting them where they’re at, rather than asking them to jump through hoops to get where they need to go.

“One of the beauties around this health hub low-barrier model isn’t just that we can get you started on care today, but if you’re not doing well and you continue to use and you stop your medication, you’re welcome back an infinite number of times,” Banta-Green said.

Banta-Green likens the hub model to not giving up on a friend, even if they make mistakes.

“You care about them and you want them to come back and that’s not like, quote unquote, accepting or enabling drug use,” Banta-Green said. “I care about the person. If the person isn’t here or present, I can’t engage with them.”

That means health engagement hubs also have to be flexible, said Maroon, whose organization already runs a low-barrier medication program for people with opioid-use disorder. If someone arrives 10 minutes late to an appointment, for example, they won’t be denied treatment or made to feel bad about it.

“In talking to people for many years now, I know that they’ve certainly had enough experiences feeling like they’re not wanted in the health care system,” Maroon said. “Any new caring setting has the potential to be able to write a new story with them.”

The Fatal Overdose Reduction Act

Under Cantwell’s legislation, organizations that want to become health hubs will need to offer medication for opioid-use disorder, harm reduction services such as overdose education, physical and behavioral health care services, social services like housing and recovery support, and outreach services.

The hubs must hire at least one health care provider licensed to prescribe controlled medications, a behavioral health provider and a nurse to provide medication management, wound care, vaccine administration and more.

They must also hire a full-time team of outreach and community engagement staff, which can include peer counselors, recovery coaches and others. At least 50% of the outreach team must be people with a personal history of addiction treatment or recovery.

“In popular opinion, when we look at one person at a time, we tend to see [addiction] as an individual failing,” Maroon said. “But in serving hundreds of people, I can safely say this is a system failure that people get caught up in. We need to try to find a new way to think about how to respond to this as a health issue, as a community issue.”

Banta-Green said he’s excited about the way the legislation is written, and some of the requirements that come from Washington’s model are even more intensive than he originally proposed, such as on-demand drop-in services.

He’s also happy to see that the legislation requires research to ensure that the design and implementation of the hub has been effective: “People are calling things policy failures when they’re implementation failures,” Banta-Green said.

Still, he said he knows the possibility of Congress passing the bill is “modest,” and the timeline for impact is “way out.”

Cantwell said that while she wants to “speed discussion along,” the opioid epidemic has moved so quickly that there hasn’t been time for “development of knowledge and consensus” among her colleagues. Still, Banta-Green’s May 23 testimony at the Senate Finance Committee impressed the other senators, she said, and she feels like the health hub is a “common sense solution.”

“We need to move fast. There’s real Americans being hurt by this crisis,” Cantwell said. “While we got some more support for trying to stop the flow of fentanyl and some support for law enforcement, we gotta get this treatment side done.”

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