The U.S. drug overdose and death epidemic has killed more than 1 million Americans in the past 25 years, which is why the AMA continues to urge removing barriers to evidence-based treatment for substance-use disorder and supports harm-reduction strategies to save lives from overdose.
Recently, the AMA declared its support (PDF) for the bipartisan Fatal Overdose Reduction Act, S. 665, introduced by Sens. Maria Cantwell (D-Wash.) and Bill Cassidy, MD (R-La.).
The bill would expand upon a program developed in Washington state, establishing the Health Engagement Hub Demonstration Program across the country. Health-engagement hubs provide low-barrier medical and behavioral health care, including substance-use disorder treatment such as buprenorphine and harm-reduction services. They also support naloxone distribution. Operated by community-based programs that follow the harm-reduction philosophy, the hubs usually coexist in the same facility as syringe-services programs.
“The AMA believes that successfully implemented health engagement hubs are positive, community-based efforts which generally take advantage of existing resources to coordinate and enhance access to care for individuals with an SUD,” wrote AMA Executive Vice President and CEO James L. Madara, MD, in a letter to Cantwell and Cassidy.
“The AMA is committed to eliminating unnecessary barriers” that stand in the way of substance-use disorder patient care, Dr. Madara wrote, “and this legislation is a welcome step toward that goal.”
Lifesaving help, right away
Washington state’s program now has five hubs, each of which is required to have physicians or other health professionals who can prescribe and provide Medicaid billable services. Additionally, each site has nurses, peers and case managers.
The health-engagement hubs (HEHs) provide same- or next-day access to services such as medications for opioid-use disorder without an appointment. Even if such medications are not the right fit, the hubs offer other harm reduction services such as overdose education and naloxone distribution.
People who use drugs illicitly often experience multiple comorbidities such as skin and soft-tissue infections, viral hepatitis and HIV. They also often experience stigma in traditional health care settings.
“Because HEHs have preexisting relationships with these communities, there is less hesitation to seek care with them,” says a joint statement from Sarah Deutsch, MPH, who manages the Washington State Health Care Authority’s Health Engagement Hubs Program, and Tim Candela, who is the drug-user health coordinator with the Washington State Department of Health.
“HEHs will be well situated to address acute health issues before they become emergent, thereby cutting costs associated with emergency room visits,” the two added, noting that this care model aims to care for each patient holistically by making same-day care available within settings they trust.
“No wrong door”
Care teams comprising a physician, nurse care manager, care navigator and a mental health coordinator work together to help a patient with basic medical and mental health services, and treatment. The teams use a trauma-informed and person-centered approach, which means patients can identify and prioritize their personal goals for their care.
By offering a “no wrong door” approach, “we see better health outcomes for patients while undoing some of the negative past experiences many patients associate with accessing medical care,” said Deutsch and Candela.
All hubs are required to have syringe-services programs. “Providing risk reduction supplies in a harm reduction manner is the foundation of this work,” the two explained.
The HEHs also employ targeted strategies to engage people at high risk of overdose through peer support, education and establishing connections in the community. All these efforts will encourage people to engage in health care services delivered at the hub, said Deutsch and Candela. They added that Washington effort is an engagement strategy formed in recognition that people who use drugs may have other health care needs and goals other than immediately entering treatment.
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One patient’s story
Through persistent follow up, the program gets patients back on their feet, according to Thomas E. Robey, MD, PhD. He is an emergency physician and medical director of one of the hubs, the Sound Pathways Health Engagement Hub in Everett, Washington.
Dr. Robey recalled the time his street-medicine team helped a patient who was six months pregnant and had not received prenatal care because of her fentanyl addiction. The team's peer counselors learned she was interested in a fetal checkup. As Dr. Robey measured the fetal femur and skull, a team nurse flagged her blood pressure as a possible sign of preeclampsia. Dr. Robey provided some temporizing medications when the patient said she wasn't ready to go to the hospital—but the baby had other plans.
“My portable ultrasound measurements of 8.5 months gestation were correct, and she delivered three days later,” Dr. Robey said.
Within two days of delivery, however, the patient was back on the street against medical advice. Her care team found her and after three separate visits that involved the team, Dr. Robey was able to coordinate care with several other agencies to get her the help she needed. The story illustrates how the first couple of visits can establish a relationship, but it takes time and persistence to support long-term change.
“Today,” Dr. Robey said, “she is still in treatment.”
Evaluating the model
The Washington State Health Care Authority is partnering with the Washington State Department of Social and Health Services and its data analytics arm, RDA, to collect data on the hubs. This will culminate in a legislative report that’s due in August 2026. The evaluation will look at certain demographic indicators as well as service-utilization patterns to assess the value of the model.
“We are also inviting patients to consent to join a cohort of folks where we can use claims data to look at overall health system utilization and outcomes,” said Deutsch and Candela.
The AMA also supports other legislation to increase access to medications for opioid-use disorder, along with broad access to naloxone. This includes H.R. 2483, the Support for Patients and Communities Reauthorization Act of 2025—called the SUPPORT Act for short. The House Energy and Commerce Committee approved the bill April 29.
The AMA believes that science, evidence and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic evolves into a more dangerous and complicated illicit drug overdose epidemic. Learn more at the AMA’s End the Epidemic website.
