Barriers for Implementing the Hub and Spoke Model to Expand Medication for Opioid Use Disorder: A Case Study of Montana

This case study identified limits to the Hub and Spoke model in supporting states’ abilities to expand access to MOUD treatment and offers suggestions for adapting it to accommodate variation across divergent rural contexts. Barriers to successfully recruit spokes l in this case study included: (1) geographic barriers, (2) a lack of interest among medical providers, (3) fears about excessive demand, (4) concerns about the financial viability of the model and others outlined in this study. The authors provide recommendations for strategies that may assist in expansion of MOUD in rural communities that are like those found in Montana.