Hub-and-spoke is a system-level approach some states use to expand access to opioid use disorder treatment, connecting specialized centers with broader primary care networks.
How it works: A specialized “hub” (often with more complex-case capacity, sometimes including methadone through an affiliated OTP) supports a network of “spoke” providers — typically primary care practices offering buprenorphine — with training, consultation, and a pathway for patients who need more complex care to step up to the hub temporarily.
Why this model exists: It aims to expand buprenorphine access broadly (through many spoke providers) while maintaining a safety net of specialized expertise (the hub) for more complex situations, rather than requiring every provider to have specialist-level addiction medicine training.
Where this is used: Several states have implemented formal hub-and-spoke systems as part of their opioid response infrastructure — availability and structure vary significantly by state.
Why this matters if you’re looking for care: If your state has a hub-and-spoke system, a spoke provider (often more accessible, sometimes your regular doctor) may be able to treat you directly, with the hub available if your situation becomes more complex — worth asking a potential provider whether they’re part of such a network.
Medically reviewed by [pending]. Sources: SAMHSA, state opioid response program documentation (structure varies by state).