1. The National Opioid Crisis

2. Overdose Deaths per 100,000
New York Times:

3. Overdose Deaths per 100,000
New York Times:

4. Overdose Deaths per 100,000
New York Times:

5. Overdose Deaths per 100,000
New York Times:

6. Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times.

7. California MAT Expansion Project
California will strategically focus on three populations to improve MAT services:
1. Counties without a NTP in the geographic area.
2. Increase the availability and utilization of buprenorphine statewide.
3. Improve MAT access for CA’s American Indian and Native Alaskan tribal communities through the IHP-MAT Project.

8. The CA H&SS Project

9. Network # & Hub location
Yuba
Yolo
Ventura
Napa
Tuolumne
Monterey
Tulare
Mono
Trinity
Modoc
Tehama
Merced
Sutter
Mendocino
Stanislaus
Mariposa
Sonoma
Marin
Solano
Madera
Siskiyou
Los Angeles
Sierra
Lassen
Shasta
Lake
Santa Cruz
Kings
Santa Clara
Kern
Santa Barbara
Inyo
San Mateo
Imperial
San Luis Obispo
Humboldt
San Joaquin
Glenn
San Francisco
Fresno
San Diego
El Dorado
San Bernardino
Del Norte
San Benito
Contra Costa
Sacramento
Colusa
Riverside
Calaveras
Plumas
Butte
Placer
Amador
Orange
Alpine
Nevada
Alameda 8 1 2 3 4 5 6 7 9 11 12 13 14 15 16 10 18 17 19
CA H&SS
Hubs and Spokes
Network # & Hub location
Spokes 1
Lake County (1)
Mendocino County (2)
Nevada County (1) 2
Siskiou County (2)
Trinity County (1)
Del Norte County (1) 3
El Dorado County (1)
Placer County (1) 4
Butte County (2)
Lassen County (1)
Tehama County (1)
Plumas County (1) 5
Humboldt County (6) 6
San Joaquin County (1)
Stanislaus County (1) 7
Contra Costa County (TBD) 8
San Francisco County (TBD) 9
Sonoma County (1)
Yolo County (1)
Colusa County (1)
Napa County (1) 10
Los Angeles County (10) 11
Marin County (8) 12
Yolo County (2)
Sacramento County (1) 13
Santa Cruz - N County (6) 14
Santa Cruz - S County (4)
San Benito County (1)
Monterey County (1) 15
Fresno County (TBD) 16
Solano County (TBD) 17
San Diego County (7) 18 19
San Bernadino County (1)
Riverside County (6)
San Diego County (2)

10. What is the Hub and Spoke?
It is designed to treat opioid use disorder as a chronic disease under the Vermont Blueprint for Health
Main goal is to prevent overdose and deal with the opioid crisis in the state
It divides Vermont into regions by counties
Each region has a specialized addiction center of expertise known as the HUB that is an opioid treatment program (OTP)
Each Hub is connected to all the waivered buprenorphine doctors’ offices known as SPOKES
All SPOKES have a dedicated MAT (medication assisted treatment) team
A MAT team is made of 1 registered nurse and 1 licensed clinical social worker for 100 patients on buprenorphine under Medicaid

11. SPOKES Linked to a regional HUB
All buprenorphine prescribers in an office can participate as SPOKES
Can be 1 doctor in private practice or group practice with many prescribers
Can refer complex patients to the HUB for stabilization
All SPOKES take advantage of the MAT teams in the region

12. MAT (Medication Assisted Treatment) Team
Cornerstone of the SPOKES effectiveness
Many buprenorphine providers had declined to increase the number of people they treated due to the extra work involved in caring for those with OUD
Consists of 1 each fulltime equivalent registered nurse and licensed clinical social worker
Pays for the services of both people per 100 buprenorphine patients enrolled in Medicaid

13. Opioid Coalitions
All CA H&SS must submit an Outreach Plan which includes how the system will participate and collaborate with the 36 local county opioid safety coalition networks.

14. CA H&SS Services Required Treatment Services
Prescribe and dispense all FDA approved MAT for an OUD
Counseling
Provide naloxone and training
HIV and HCV testing and referral to services
Case management
Professional medical, social work, and mental health services, offered to patients onsite or by referral
Recovery and/or peer support services
Local access to maternal addiction treatment
Serve as the subject matter expert on opioid dependence and tx to the Spokes
Utilize the OBOT Stability Index and the Treatment Need Questionnaire tool

15. California Opioid Hub and Spokes Project
DHCS
Marlies Perez, State Project Director
Michael Freeman, Project Manager; Kevin Masuda, Project Analyst
CA H&SS
Implementation Team
UCLA
Richard Rawson, Principal Investigator
Mark McGovern (Stanford), Learning Collaboratives
Thomas Freese, Training/Technical Assistance
Gloria Miele, Learning Collaborative Coordinator
Beth Rutkowski, Training Liaison
Training Coordinator and assistants
Consultants
John Brooklyn
Tony Folland
Barbara Cimaglio
Regional CA Addiction and Primary Care MDs
Evaluation Team
Darren Urada, Principal Investigator
Vandana Joshi, Co-Investigator
Howard Padwa, Co-Investigator
Data Collection Coordinator and assistants
Advisors
Betsy Hall
Yih-Ing Hser
Lynn Brecht
UCLA
Program Director
Valerie Antonini
Advisory Group Implementation & Evaluation experts, H&SS participants, community members, DHCS representatives, CSAM, CHCF
CSAM
Kerry Parker, Jean Marsters, MD, Steve Eickelberg, MD
CHCF
Kelly Pfeifer, MD

16. California Opioid Hub and Spokes Project Implementation Activities
Implementation Team
UCLA
Chair: Richard Rawson; Co-Leader: Valerie Antonini
Learning Collaboratives: Mark McGovern, Gloria Miele
Purpose: Engage H&SS participants in process of shared learning and experience to facilitate implementation of services, assist with procedural changes, and provide opportunities for interactive problem solving.
Activities: Conduct Regional Quarterly LC meetings
Training and Technical Assistance: Thomas Freese, Gloria Miele, UCLA Trainers
Purpose: Meet training and technical assistance needs of H&SS participants through just-in-time training including online self paced courses, in person and online training.
Activities: Bi-annual Best Practices conferences, Bi-annual Clinical Skills trainings, Quarterly community-wide MAT training, and ongoing assistance with additional resources.
Consultants
Consultants will be available to provide additional technical assistance including:
John Brooklyn, Tony Folland, Barbara Cimaglio, Kelly Pfeifer/CHCF, and California Addiction and Primary Care MDs.
CSAM
Jean Marsters, MD, Steven Eickelberg, MD, Kerry Parker
Purpose: Provide support to providers in spokes to build confidence in prescribing
Activities: Four-day mentored learning experiences for approximately 60 spoke participants who will attend the CSAM Annual Conference in August 2018 in San Francisco; updating of the Guideline for Physicians Working in CA Opioid Treatment Programs published in 2009; and two CSAM educational webinars

17. Training and Technical Assistance Face-to-Face Training
Skill based trainings
provide guided practice of skills with feedback (e.g., practicing MI skills)
Opportunity for learning from the experience of other H&SS networks
Demonstrations of evidence-based practices
Developing strategies for implementation in clinical settings
Community Forums on MAT
Distance and face-to-face training for the community at large to broaden understanding of MAT, why it’s important, and how the medicines work
Opportunity for discussion of hopes and concerns among participants about the planned expansion of MAT services

18. Tribal MAT Project
Funding specific to the American Indian and Alaskan Native
Project Echo
Suicide Prevention
Naloxone Distribution to First Responders
Culturally Specific MAT Programs
Needs Assessment, Education and Training
Support for MAT Access Expansion under the Indian Health Program-ODS

19. California Society of Addiction Medicine
Mentoring Scholarships for 75 physicians
Revising NTP Guidelines with all FDA Approved Medications
Webinars and other MAT training
Members of the MAT Expansion Project Roll-out
Assisting with recruitment of waivered prescribers for the spokes in the CA H&SS

20. CALIFORNIA H&SS UNPRECEDENTED OPPORTUNITY
To save lives and to foster recovery
To succeed or fail as care providers
To innovate or do more of the same
To destroy stigma and discrimination for persons who suffer addiction
To bring care of addiction into the “big house” of health care
To develop practices, processes and relationships that last---