Hub-And-Spoke Architect: Program Like 'Inoculating Everybody With A Flu Shot'

Jan 10, 2019

When Gov. Peter Shumlin spent his entire 2014 State of the State address talking about drug addiction, John Brooklyn had already been enmeshed in the world of addiction treatment for more than a decade.

Brooklyn is one of the doctors who came up with a model of substance use treatment that's spread across Vermont in the last five years, called hub-and-spoke. Now, other states, like New Hampshire, are looking to replicate it.

Listen to John Brooklyn's conversation with Henry Epp above.

Brooklyn said the idea behind the model is to allow patients who need medication-assisted treatment to receive quick access to higher or lower levels of care as needed.

This is part of a series of interviews airing on VPR this week to mark the five-year anniversary of Shumlin's State of the State speech on addiction. Check here for more stories throughout the week.

"It's trying to mirror what exists in the rest of healthcare," Brooklyn said in an interview inside Howard Center's Chittenden Clinic in South Burlington. "So for instance, if you came to see me as a primary care doctor and you're having incredible chest pain and I thought you were having a heart attack I would send you to the E.R. You would probably see a cardiologist and you'd be admitted and taken care of, and then you'd be discharged and you'd come back to me."

Below are some excerpts from John Brooklyn's interview with Henry Epp:

On How Shumlin's Speech Changed The Approach To Treatment

"It seemed as though the discussions around keeping people safe, identifying people, getting them to treatment, became elevated," Brooklyn said.

"There's always been this dynamic in the addiction community about treating with medication and abstinence, and I think that that's been a false dichotomy. And so I think bringing those two cultures together and having a more robust conversation about, 'Yes, people can go to meetings, they can be involved in recovery activities, they can engage in many things to help build their lives and also be on medication,' the joining of those two things seem to coalesce much more after that speech than before."

Access To Treatment Still A Struggle

Waitlists at treatment hubs in Vermont have been eliminated in recent months, but Brooklyn said there are still barriers to treatment for many Vermonters living in rural communities.

"Starksboro's not next to Burlington. It's not next to Montpelier, it's not next to Rutland. Those are the nearest hubs. So if somebody lives in Starksboro, they still have to travel ... to a hub, unless they have a local spoke provider."

"If you have to go to work at 7 a.m., and you have to drive 30 miles one way, but to the clinic 30 miles the other way, you're probably not going to go to the clinic because it's too much trouble. So I think the next thing we need to think about is how can we get treatment closer to each community, so that that many more people are willing to come into treatment."

Benefits Of Focusing Resources On Addiction Treatment

"If I think about all the people that I take care of who are now in treatment, who are working, who are no longer receiving welfare, who are housed, who are paying taxes, who no longer have DCF in their life, who no longer incarcerated, it's staggering how much the state has saved," Brooklyn said.

"I think about the 8,000 people that are in treatment ... I'm not saying all 8,000 of them are doing fantastic, but the number of people per capita getting treatment and doing well I think speaks for itself. And so you would have to say economically, societally, that we're benefiting all the way around by having this many people in treatment and funding it because ultimately it makes our citizenry healthier, cuts down on overdose deaths, and reduce hospital costs, and makes people just that much happier and productive citizens."

This is part of a series of interviews airing on VPR this week to mark the five-year anniversary of Shumlin's State of the State speech on addiction. Check here for more stories throughout the week.