CITIZEN VOICES® Hub and spoke drug treatment system in NH

Feb 27, 2019

In 2018, the New Hampshire Department of Health and Human Services won a $45 million grant to help fund a new statewide system for curbing opioid addiction. The new “hub and spoke” program, which kicked off on January 1, creates an organized network of treatment providers for those battling addiction. 

How it works 

There are nine opioid treatment “hubs”  most of them hospitals  where those seeking treatment can find immediate care. Patients who arrive at hubs are given initial screening, assigned a case manager, and, if necessary, started on medication-assisted therapy.  

From there, these patients are referred to impatient detox centers, recovery housing or other community resources to address their needs. These secondary treatment services are the “spokes” of the hub and spoke model. 


One challenge for New Hampshire’s hub and spoke system has to do with the shortage of behavioral health care providers. Vermont, which has pioneered the hub and spoke system for the past five years, has had difficulty extending treatment options to rural parts of the state. New Hampshire may struggle with similar issues.  

Part of that shortage is due to low Medicaid reimbursement rates.  When a Medicaid patient seeks mental health care, New Hampshire reimburses mental health providers at around 58 percent of what commercial carriers do. New Hampshire’s Medicaid reimbursement rates are also much lower than the national average 

Some also fear the hub and spoke model will draw attention and funding away from existing programs, like Safe Stations. 

Opportunities to make progress 

Proponents point to the overall success Vermont has enjoyed using the hub and spoke system. The state has demonstrated an improved ability to handle the influx of opioid addiction cases. New Hampshire health officials see the hub and spoke method as a way to organize what has been a chaotic system for treating drug addiction.  They believe this system, which creates a path from immediate intervention to long-term care, will result in fewer patients falling through the cracks.  They also hope it will increase opportunities for treatment outside Nashua and Manchester. 

Learn more about NH’s new drug treatment system 

To learn more about this issue, check out these related articles from members of the Granite State News Collaborative:

Manchester Ink Link

Part 1: NH’s Hub and Spoke System: Traction or just spinning wheels? 

Part 2: Safe, for now: Future of Safe Station not clear in wake of hub-and-spoke

Part 3: Numbers tell the story in Vermont hub-and-spoke

Or read more from these outlets:

The Laconia Daily Sun

The Nashua Telegraph


Have you or a loved one sought out treatment for opioid addiction in New Hampshire? What was your experience like?

Citizens Count is hosting this discussion as part of our work with the Granite State News Collaborative, a robust group of media, educational and professional outlets working together to add missing dimensions to coverage of issues of concern in New Hampshire. This topic is being covered by the collaborative as part of their premiere project, Granite Solutions, which provides in-depth, evidence-based reporting on behavioral health. 

See additional comments on this question from Facebook


Bob Bogardus
- Farmington

Sun, 04/21/2019 - 1:17pm

The "live free or die" state - should change its name to " The Die State "! Predominantly " outdated attitudes - due to outdated facts" on a multitude of issues. Have a "loved one" who is addicted and THE OUTDATED and comparatively Addictive "Methadone or Suboxone Treatment in New Hampshire" is a HUGE Failure! Also many addicts are " homeless and without means - so to have them " walk in and medicate " then BACK TO THE STREETS IS DISGRACEFUL. I have little doubt that most of the Federal money ( for addiction treatment ) is being " redirected to the General Fund " as the state die with Medicaid Money ( back in the 80's ). Why don't LEGISLATORS and our Governor " spend some time READING on Current Affairs nationally on Opioid Treatment " - States that have " legalized Cannabis " have seen the use of opioids DECLINE significantly ! A majority of citizens have backed legalizing cannabis for YEARS - but our legislators are still stuck in the " Reefer Madness " Propaganda Days and " can't seem to find their path TO THE PRESENT ". If nothing else - AT THE VERY LEAST - " Gov Sununu and State Legislators SHOULD RECONSIDER SB-175 " TO allow " DOCTORS AND DOCTOR ASSISTANTS TO PRESCRIBE MEDICAL CANNABIS for any condition THEY DEEM PROPER " - The Governor and Legislators " Have NOWHERE NEAR THE KNOWLEDGE to Pick and Choose Conditions that Warrant Medical Cannabis USE " ! Cutting Edge states are currently proposing Cannabis for OPIOID TREATMENT, but of course New Hampshire " isn't CUTTING EDGE - is it " ?.........TIME FOR TERM LIMITS IN CONCORD - " perhaps a Decade would be a good place to start " - AND WE NEED A GOVERNOR who Governs by LISTENING TO THE " Majority Voice " of the states Residents. Perhaps some " results from U.N.H. polling could supply a hint on issues " - You know " Academia " - an Educated Source..................sigh...............

Joel Moran
- NewBoston

Fri, 03/29/2019 - 7:04pm

No ; The media makes NH sound like everyone is on drugs here!

Tom Ploszaj
- Center Harbor

Sun, 03/03/2019 - 1:59pm

No extra monies at this time. None of our love ones has even had an opiod issue. Three of us has worked as medical first responders.
Stop throwing money up into the sky, hoping it will fall into useful programs.
How about a pay for success option?
An option to make tax dollars efficient is to put any funds into escrow. Opioid/addition treatment programs that can show they have reduced drug use recidivism can then apply for increase in payments.

Terry Melle
- Gilmanton Ironworks

Sun, 03/03/2019 - 8:21am

The greater concern is our lazy tendency too rely on the "State". It wakes us complacent and feeds their desire for total control of all aspects of life.

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