In the News
Psychiatric News: How PHI’s CA Bridge is Fighting the Opioid Crisis in the ED
In Psychiatric News, PHI’s CA Bridge is highlighted for its successful approach of training and supporting physicians in initiating buprenorphine for patients with opioid use disorder when they visit the emergency department.
- Psychiatric News
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Focus Areas
Alcohol, Tobacco, Drugs & Mental Health, Capacity Building & Leadership, Health Care & Population Health -
Programs
Bridge, CA Bridge -
Strategic Initiatives
Opioids
“In 2021, an estimated 2.5 million people had opioid use disorder (OUD), and only 22% of them received medications to treat it. The sheer scale of the opioid crisis fuels its continued growth, like a storm creating its own wind. “It expands and expands as new people are drawn in through social connections and networks,” said Andrew Herring, M.D., an emergency, pain, and addiction physician in Oakland.
The only viable solution, according to Herring, is one that can match that scale. “And the only reasonable intervention that we really have that can safely and pragmatically meet the scale of the need is buprenorphine,” said Herring, an attending emergency physician and associate director of research at Highland Hospital-Alameda Health System, where he also serves as medical director of the substance use disorder treatment program.
Though an opioid itself, buprenorphine is safe, has lower abuse potential compared with other opioids, and ensures greater safety in case of overdoses. It provides a reasonable path for the millions of people living with OUD to begin their transition away from the illicit market, Herring said.
Emergency departments are incredibly successful. It is the only place where everyone, across the country, can receive treatment regardless of their ability to pay.Andrew Herring, M.D.
Program Director, Bridge Center, Public Health Institute
But buprenorphine can’t be the solution if it doesn’t reach patients. Enter the CA Bridge program, which is conducting one of the largest efforts in the United States to encourage emergency clinicians to initiate buprenorphine when patients with OUD enter their emergency departments (EDs). CA Bridge is one component of the Bridge Center, a California organization founded by Herring, Aimee Moulin, M.D., and Arianna Campbell, D.M.Sc., M.P.H., PA-C, to integrate emergency care with community care and improve health equity.
The ED [emergency department] is a really crucial place to offer treatment for people with substance use disorders because that’s where patients are going when they’re not connected to outpatient care. People are often trapped in cycles of use and withdrawal. The windows when we can find them, treat their withdrawal, and bring them into treatment are narrow. We need to take advantage of them.Dr. Aimee Moulin
PHI Bridge Senior Director, Principal Investigator
Successes So Far
Since its inception in 2018, CA Bridge had been implemented in 291 EDs—which account for 88% of emergency departments in California. The program provides emergency clinicians with free resources about buprenorphine and other medications for addiction treatment best practices. The key to expanding CA Bridge, Moulin said, was making phone calls. “Lots of phone calls,” she said. “We made a concerted effort to do outreach to everybody.”
A recent study in JAMA highlighted the extent of the program’s impact: The rate of California patients receiving their first buprenorphine prescription from an emergency room clinician increased from 0.1% in 2017 to 5% in 2022. Emergency clinicians accounted for just 2% of all buprenorphine prescribers in 2017, but by 2022 they accounted for 16%. Among individuals who initiated buprenorphine in the ED, one in three went on to receive a second prescription within 40 days. Finally, for every nine patients who had buprenorphine initiated by an emergency clinician, one patient achieved 180 days or more of continuous prescriptions within one year.”
Click on the link below to read the full article.
Originally published by Psychiatric News
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