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California Bridge Program

This statewide program in California provides access to medications for opioid use disorder in the emergency departments of 53 hospitals and links to treatment

Recognizing that the emergency department is a potential vital touchpoint for initiating evidence-based interventions for opioid use disorder (OUD), the California Bridge Program is a partnership with the California Poison Control System and the California Hub and Spoke System to provide 24-7 emergency access to initiation of buprenorphine treatment for OUD in all California communities. 

The program is built on three pillars: 

  • Treatment: Medications for opioid use disorder (e.g. buprenorphine) are accessible in the emergency department and in all other hospital departments.  Treatment is provided rapidly in response to patient needs, not contingent on laboratory screening results, insurance status, commitment to treatment, or abstinence from all substances. Providers use a harm reduction approach and put patient needs at the center of the path to treatment
  • Culture: Hospital culture is welcoming and does not stigmatize substance use, making disclosure of substance use inviting. There is a focus on using destigmatizing language.
  • Connection: Linkage to ongoing care involves active support and follow up with patients. There is an arrangement with at least one community provider to accept referrals within 72 hours after buprenorphine is initiated in the emergency department. 

More information on the program can be found in this presentation and this guide. 

Publications addressing initiation of buprenorphine in the emergency department can be found at this link. The program also offers a website that guides clinicians on how to implement a bridge clinic, including clinical protocols, best practices, and toolkits.

How this program finances the delivery of this intervention is highlighted in this blog.  

This program reported a sharp statewide decrease in its efforts to expand access to buprenorphine as a result of the COVID-19 pandemic. 

The emergency department could be a vital touchpoint to initiate evidence-based treatment for opioid use disorder. 

Continuum of Care
Treatment
Type of Evidence
Peer-reviewed
Response Approach
COVID / Coronavirus related
Early Intervention
Medications for Opioid Use Disorder
Peer-reviewed Article
Voting with their feet: Social factors linked with treatment for opioid use disorder using same-day buprenorphine delivered in California hospitals
Sharp decline in hospital and emergency department initiated buprenorphine for opioid use disorder during COVID-19 state of emergency in California
Rapid Adoption of Low-Threshold Buprenorphine Treatment at California Emergency Departments Participating in the CA Bridge Program
Related Resources
Guidelines for Medication for Addiction Treatment for Opioid Use Disorder within the Emergency Department
Hospitals’ Role in Addressing the Opioid Crisis: Buprenorphine in the Emergency Department
Emergency Discharge Protocols for Patients with Substance Use Disorders and Opioid Overdoses in Maryland’s Hospitals
Emergency department screening and interventions for substance use disorders
Routes of Non-Traditional Entry into Buprenorphine Treatment Programs
Medication-Assisted Treatment With Buprenorphine: Assessing the Evidence
Planning and Designing the Improving Addiction Care Team (IMPACT) for Hospitalized Adults with Substance Use Disorder
Medications for Opioid Use Disorder Save Lives
A Novel Social Work Approach to Emergency Department Buprenorphine Induction and Warm Hand-Off to Community Providers

Evidence of Program Effectiveness

"Over a 14-month implementation period, 12,009 opioid use disorder patient encounters were identified, including 7,179 (59.7%) where buprenorphine was administered and 4,818 (40.1%) where follow-up visits were attended...By program completion, all 52 (100%) hospitals treated opioid use disorder with buprenorphine; 45 (86.5%) administered buprenorphine after naloxone reversal; 41 (84.6%) offered buprenorphine for inpatients; 48 (92.3%) initiated buprenorphine in pregnant women; and 29 (55.8%) offered take-home naloxone. At 8-month follow-up, all 52 sites reported continued buprenorphine treatment...Low-threshold ED buprenorphine treatment implemented with a harm reduction approach and active navigation to outpatient addiction treatment was successful in achieving buprenorphine treatment for opioid use disorder in diverse California communities." (Snyder et al., 2021)

"Most patients received hospital-administered buprenorphine (58 %) and/or a buprenorphine prescription (55 %); 26 % received neither treatment. Patients with unstable housing had greater odds of hospital-administered buprenorphine compared to patients with stable housing. Patients with Medicaid had greater odds of receiving a buprenorphine prescription compared to patients with other insurance. Co-methamphetamine use was not associated with outcomes...Patients with OUD are successful in accessing same-day MOUD in CA Bridge hospital settings over a significant period. Importantly, access to MOUD in these settings was facilitated for patients traditionally not treated using buprenorphine, i.e., those with housing instability, Medicaid insurance, and co-methamphetamine use. Findings suggest barriers to MOUD for patients with social and economic disadvantages can be lowered by changing treatment delivery." (Kalmin et al., 2021)